AC 4372 WOO 2 Metropolitan Borough of Woolwich. ANNUAL REPORT Medical Officer of Health 1927. J. MACMILLAN, D.S.O., M.C., M B. D.P.H., Medical Officer of Health. Woolwich The "Kentish Independent" Printing Works (T.U.) 16. Wellington Street. Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1927. BY J. MACMILLAN, D.S.O., M.C., M.B., D.P.H., Medical Officer of Health. Woolwich: The "Kentish Independent" Printing Works (T.U.) 16, Wellington Street. 3 Public Health and Housing Committee. At 31st December, 1927. His Worship the Mayor (Councillor C. H. Langham, J.P.). Councillor Miss M. Crout, J.P. (Chairman). Alderman Mrs. E. Dormer. J.P. (Vice-Chairman). Alderman— A. Gorman. Councillors— R. M. W. Allen W. E. Hughes Narborough E. Brown T. H. Thompson P. Chinnery Miss S. Turnbull T. Davis H. J. Turner A. H. Gilder Miss G. E. Walters, J.P. W. G. McCartney R. A. M. Walters Maternity and Child Welfare Committee. Comprising the Members of the Public Health and Housing Committee. 4 TABLE OF CONTENTS. page Public Health and Housing Committee 3 Maternity and Child Welfare Committee 3 Preface 8 I.—General Statistics. Social Conditions 11 Population 12 II.—Vital Statistics. Annual Statistics 15 Births 17 Marriages 19 Deaths 19 Maternal Mortality 27 Child Mortality 30 Infantile Mortality 32 III.—General Provision of Health Services. Hospitals 38 Institutional Provision for Unmarried Mothers 39 Ambulance Facilities 39 Clinics and Treatment Centres 40 Staff 42 Professional Nursing in the Home 45 Midwives 46 Chemical Work 46 Bacteriological Examinations 46 Adoptive Acts, Bye-laws and Regulations in force in the Borough 46 Heatlh Week 50 IV.—Sanitary Administration. staff 53 Complaints 53 Closet Accommodation 53 Scavenging 53 Combined Drains 54 5 page Sanitary Inspection of Area 55 Rate 58 Mosquitoes 59 Rag Flock 59 Offensive Trades 59 Smoke Abatement 60 Factories and Workshops 60 Legal Proceedings 62 Mortuaries and Cemeteries 64 V.—Inspection and Supervision of Food. General Reference 66 Milk Supply:— Registration 67 Cowkeepers 67 Dairymen and Purveyors of Milk 68 Designated Milks 68 Meat Supply 71 Slaughterhouses 72 Other Food Premises:- Bakehouses 73 Fried Fish Shops 73 Ice Cream 73 Other Premises 73 Unsound Food 73 Food Poisoning 74 Sale of Food and Drugs Acts 74 Public Health (Condensed Milk) Regulations, 1923 77 Public Health (Dried Milk) Regulations, 1923 77 Public Health (Milk and Cream) Regulations, 1912-1017 78 Adulterated Samples—Action Taken 79 Other Legal Proceedings 81 VI.—Housing. Statistics 83 General Reference 85 Houses Let in Lodgings 87 Housing Act, 1925 87 Underground Sleeping Rooms 88 Tents and Vans 88 Increase of Rent and Mortgage Interest (Restrictions) Acts 89 New Houses 89 6 VII.—Infectious Diseases. page Notification 93 Smallpox 99 Scarlet Fever 99 Diphtheria 101 Enteric Fever 102 Encephalitis Lethargica 103 Cerebrospinal Meningitis 104 Pneumonia 104 Erysipelas 106 Malaria, Trench Fever and Dysentery 106 Puerperal Fever and Puerperal Pyrexia 106 Ophthalmia Neonatorum 107 Zymotic Enteritis 108 Whooping Cough 108 Measles 108 Anterior Poliomyelitis 109 Disinfection and Disinfestation 109 Tuberculosis:— General Reference 111 Notifications 112 Deaths 114 The Public Health (Prevention of Tuberculosis) Regulations, 1925 116 The Work of the Dispensary 117 Contacts 120 Co-operation with Hospitals, etc. 121 Co-operation with Local Practitioners 121 Co-operation with School Medical Service 122 Home Nursing 122 Provision of Extra Nourishment 123 Dental Treatment 123 Shelters 123 Bacteriological Examinations 123 Institutional Treatment 123 Woolwich Tuberculosis Care Committee 124 VIII.—Maternity and Child Welfare. Staff 127 Administrative Action 127 Welfare Centres 128 Work of the Centres 128 Artificial Sunlight Clinic 133 7 page Voluntary Centre 133 Collective Teaching 133 Treatment of Minor Ailments 135 Work of the Health Visitors 135 Orthopaedic Treatment for Children under Five Years of Age 130 Dental Treatment 138 Institutional Midwifery 138 Institutional Provision for Unmarried Mothers 130 Provision of Nursing Assistance 140 Research Work on the Health of the Toddler 140 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 141 Supply of Milk, etc., to Necessitous, Expectant and Nursing: Mothers, and Milk to Young Children 141 The Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 142 Feeding of Infants 143 Meteorology. 8 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich . Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Twenty-Seventh Annual Report on the health of the Metropolitan Borough of Woolwich. As in previous years the Report follows as to contents and arrangement the outline indicated by the Ministry of Health in Circular No. 834, in order to ensure uniformity in the presentation of Annual Reports of Medical Officers of Health throughout the country. Accounts of the various services are given in detail in the different sections of the report but it is usual to refer briefly to a few aspects of the work here. The chief vital statistics of the year are as follows : the population was estimated by the Registrar General as 140,770 and, including military, 144,770. These figures somewhat surprisingly show a decrease on those of the previous year, and in part I. of the Annual Report this matter is fully discussed. The birth rate, 15.9, is lower than in any previous year ; the marriage rate, 13'9, also shows a decrease compared with previous years ; the death rate, 10.6, although the lowest in London, was slightly higher than in the previous year ; the infantile mortality figure, 42, is the lowest yet recorded in the annals of the Borough and is the second lowest in London. On the whole, the vital and morbid statistics for the year are satisfactory and show that the Borough maintains its position as one of the healthiest in the metropolis. 9 The general provision of health services in the area is fully set out in Section III., where also is to be found an account of the Council's propaganda work during the year. During the year more houses were erected than during any post-war year. The number was 1,083, and the vast majority of these were erected on the Council's estate at Eltham. This rapid increase has had some effect on overcrowding in the Borough, but it has by no means provided a solution of this problem. Even if it had there still remains the problem of the huts at Eltham and Abbey Wood. These hutments were built during the war years as a temporary measure and, as the years go on, they require more and more attention to keep them in a proper state of repair. The housing figures for 1927, however, compare very favourably indeed with those of 1926, when only 370 were erected. The work of the sanitary section of the department is dealt with in Sections IV. and V., and partly in Section VI. In the day's work of a sanitary inspector a great deal of change has taken place in recent years, in that more and more time is being devoted to the supervision of food supplies, not only in their sale but in the conditions under which they are prepared and stored pending sale. Under the Public Health (Meat, etc.) Regulations, every carcase killed in the borough has to be inspected. The immense increase in this side of the work will be realised when it is pointed out that over 21,000 carcases were inspected last year mainly at the slaughterhouse in Abbey Wood, whereas two years ago the figure was 13,000. The incidence of infectious disease was lower than in 1926, mainly due to the absence of an epidemic of measles. Excluding measles, the number of notifications was practically the same as in 1926, but there was a definite fall in the incidence of diphtheria and an increase in the case of scarlet fever. At the end of the year there were 1,136 cases of pulmonary and 10 300 cases of non-pulmonary tuberculosis, making a total of 1,496 cases known to be living in the Borough. These tuberculosis figures show a considerable decrease compared with the previous year, but this is due mainly to the fact that the register was carefully revised during the year and all persons in whom the disease could properly be described as arrested or cured were struck off the register. So far as maternity and child welfare work is concerned, two important changes took place during the year. The inadequate premises at the new Town Hall were replaced by more commodious and suitable premises at the old Town Hall, and a sunlight clinic was established. In addition, a complete scheme for the administrative control of puerperal fever received the approval of the Ministry. It is described in Section VIII. The attendances at the welfare centres, although slightly lower than in 1926, were well up to the average. It is again a pleasure to be able to record my appreciation of the keen, conscientious, and able manner in which the staff of the Health Department have risen to the many and new demands placed on them during the year, and I also gratefully acknowledge the kindness and consideration which I have received from the members of the Council, particularly from the members of the Health Committees, to all of whom I accord my thanks. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 11 Twenty-seventh Annual Report on the Health of the Metropolitan Borough of Woolwich Year ending 31st December, 1927. SECTION I.—GENERAL STATISTICS. TABLE No. 1. Area (acres) 8,282 Population, 1927:— Total (including military) 144,770 Civilians 140,770 Number of Inhabited Houses, 1921 26,048 Number of Families or Separate Occupiers, 1921 33,647 Rateable Value (October, 1927) £1,063,953 Sum Represented by a Penny Rate (October, 1927) £4,433 Social Conditions. Woolwich may be described as one of the surburban working-class metropolitan boroughs. It comprises the three Civil Parishes of Woolwich, Plumstead and Eltham, and its area is 8,282 statute acres. In Woolwich Parish there are 1,135 acres, in Plumstead 3,387, and in Eltham 3,760 acres. The River Thames covers approximately 12 an additional 645 acres. Much of the Borough is unbuilt on and the number of persons per acre varies from 8 in Eltham to 32 in Woolwich, the general average of the Borough being 17. Population. The Registrar General estimates the population of the Borough to the 30th June, 1927, as : Civil, 140,770, and Total, 144,770. These figures have come as a surprise to me as the corresponding figures for 1926 were 141,900 and 146,200. It should be borne in mind that in estimating populations in various areas in this country the Registrar General adopts a uniform system, and this explains why differences may arise between figures calculated by him and by Medical Officers of Health. In Woolwich, much building has been going on (it is interesting to note here that during the year ending June, 1927, 499 houses were erected in the Borough) ; there is definite evidence that the Londoner still shews a tendency to move from the centre boroughs to those on the circumference, and the figures of the 1921 census shewed that the increase in the population of Woolwich during the inter-censal period 1911-1921 (16 per cent.) was the highest of any of the London boroughs. We assume from the above that the population of Woolwich is continuing to increase, but not necessarily at the same rate. The natural increase of population, i.e., the excess of births over deaths, in the year under review, was 751, and in a borough where many new houses are being erected and unoccupied ones are difficult to find, this natural increase alone is sufficient reason to shew that the population is increasing and not decreasing. Some further confirmation of this will be found in the fact that on the voters' roll in October. 1926, there were 74,124 persons, and in 1927, 74,543. My estimate of the population of the Borough to the middle of 1927 was 145,620, but, as the practice in recent years has been to accept the figures of the Registrar-General for comparative statistical purposes, his figures have again 13 been adopted this year and populations of the registration districts of the Borough have been calculated. It has been necessary in these calculations to make allowance for transfers which have taken place under the Council's housing scheme from Woolwich and Plumstead to Eltham, and figures are available to shew that nearly 4,000 persons have moved from these districts to the Council's housing estate. Internal movement of the population in the Borough can also be traced by a study of the Council's operations under the Small Dwellings Acquisition Acts. Here we can see movement not only to Eltham but also towards East Plumstead and away from Woolwich and West Plumstead, and in the population calculations this movement also has been taken into account. Due weight has also been given to the natural increase in each of the registration districts and to the location of new houses. I am of opinion that since the last Census there has been a slight increase in the population of Woolwich and West Plumstead, but that a considerable increase has taken place in East Plumstead, and a much greater increase in Eltham, but, for the reasons stated above, the calculations only shew increases in East Plumstead and in Eltham. The estimated figures for the districts are as follows:— TABLE No. 2. Estimated population. Woolwich 31,104 West Plumstead 39,636 East Plumstead 35,254 Eltham 34,776 140,770 These figures have been used throughout the Report for calculating the rates in the Borough and the various registration districts. 14 The civilian populations of the various registration districts of the Borough at each Census since 1901, and also the estimated populations for the years 1922-1927, are as follows:— TABLE No. 3. Woolwich. West Plumstead. East Plumstead. Eitham. The Borough. *1901 35,998 38,569 29,758 7,226 111,551 *1911 31,204 40,328 30,888 13,450 115,870 *1921 32,097 40,955 34,947 28,308 136,307 1922 32,545 41,544 35,450 28,715 138,254 1923 32,620 41,249 35,552 30,579 140,000 1924 32,578 41,011 35,438 30,952 139,980 1925 32,494 40,830 35,589 31,827 140,740 1926 32,277 40,589 35,688 33,346 141,900 1927 31,104 39,636 35,254 34,776 140,770 *Census Years. 15 SECTION II.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shewn below :— TABLE No. 4. Births—Legitimate 2,175 „ Illegitimate 67 2,242 Birth Rate 15.9 Deaths 1,491 Death Rate 10.6 Number of Women dying in, or in consequence of Child Birth 6 (a) From Sepsis 3 (6) From other causes 3 Deaths of Infants under one year 95 (a) Legitimate 93 (6) Illegitimate 2 Infantile Mortality rate 42 Deaths from Measles (all ages) 1 ,, „ Whooping Cough (all ages) 10 ,, ,, Diarrhoea (under 2 years) 5 The chief Vital Statistics since 1901 are given in the following table:— 16 TABLE No. 5. Year. Population estimated to middle of each Year. Births. Nett deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. Rate per 1,000 Nett Births. Number. Rate. Number Rate. 1 2 3 4 5 6 7 8 1901 117,652 3536 30.1 457 129 1709 14.6 1902 119,285 3734 31.3 467 125 1837 15.4 1903 117,842 3684 31.3 398 108 1638 13.9 1904 118,456 3535 29.8 477 135 1763 14.9 1905 118,589 3546 29.9 362 102 1604 13.5 1906 119,143 3549 29.8 388 109 1668 1.40 1907 119,704 3330 27.8 373 112 1616 13.5 1908 122,258 3176 26.0 300 94 1516 12.4 1909 120,227 2947 24.5 242 82 1587 13.2 1910 121,197 2842 23.6 242 85 1418 11.7 1911 121,487 2810 23.1 272 97 1566 12.9 1912 121,932 2776 22.8 208 75 1456 11.9 1913 122,382 2833 23.1 228 80 1549 12.7 1914 122,431 2838 23.2 241 85 1706 13.9 1915 a 138,200 2839 21.9 268 94 1837 14.2 b 129,505 1916 a 141,783 3068 23.5 213 69 1704 13.1 b 130,313 1917 a 147,078 2718 20.6 216 79 1566 11.9 b 131,942 1918 a 150,650 2548 19.0 270 106 2100 15.6 b 134,453 1919 a 141,918 2737 20.1 235 86 1679 12.3 b 136,237 1920 a 140,000 3658 26.9 224 61 1487 10.9 b 135,904 1921 a 141,700 3197 23.2 197 62 1594 11.6 b 137,604 1922 a 142,350 2941 21.3 184 63 1603 11.6 b 138,254 1923 a 143,530 2867 20.5 123 43 1387 9.9 b 140,000 1924 a 144,400 2590 18.5 168 65 1543 11.0 b 139,980 1925 a 145,440 2582 18.3 141 55 1519 10.8 b 140,740 1926 a 146,200 2463 17.4 107 43 1450 10.2 b 141,900 1927 a 144,770 2242 15.9 95 42 1491 10.6 b 140,770 a Total population. b Civil population. 17 BIRTHS. During the year, 2,366 births were registered in Woolwich ; 1,220 were males and 1,146 females. Corrected by outward and inward transfers, these numbers become 2,242, 1,157 and 1,085, respectively. The corrected figures for the different registration districts are shewn in Table No. 6. which follows:— TABLE No. 6. Registration Districts. Males. Females. Total Births. Woolwich 314 287 601 West Plumstead 333 298 631 East Plumstead 256 246 502 Eltham 254 254 508 The Borough 1,157 1,085 2,242 The birth rate, calculated on the civilian population, was 15.9, compared with 17.4 in 1926. This is the lowest birth rate in the history of the Borough. The following Table, No. 7, shews the birth rates in each registration district, after correction for outward and inward transfers, for each year since 1923. TABLE No. 7. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 1923 25.2 18.2 18.5 20.7 20.5 1924 23.6 16.8 15.9 18.4 18.5 1925 23.1 17.0 16.1 17.6 18.3 1926 21.9 16.1 16.4 15.8 17.4 1927 19.3 15.9 14.2 14.6 15.9 B 18 Illegitimate Births. The number of illegitimate births registered was 68. There were 21 inward transfers and 22 outward transfers, making a net figure of 67, equivalent to 29 per 1,000 births. Natural Increase of Population. This term means the excess of births over deaths. In 1925 it was 1,063, in 1926. 1,013, and in 1927 it was 751. Notification of Births. During the year, 2,368 live births were notified. This is at the rate of 100 per cent. of registered births, and compares with 95 per cent. last year. 1,120 notifications were received from midwives, 154 from doctors, 90 from parents, 60 from other persons, 630 from the British Hospital for Mothers and Babies, 200 from the Military Families Hospital, 51 from the Woolwich Infirmary. 13 from the Woolwich and Plumstead Maternity Home, and 7 from the Eltham Cottage Hospital. Forty-three births took place in midwives' homes. In addition to these, 50 notifications were received from the Medical Officer of Health, Greenwich ; 45 from the Medical Officer of Health, Lewisham ; and 35 from other Medical Officers of Health. Sixtytwo still births were notified. It is known that 855 births took place in institutions, either within or without the Borough, so that the percentage of institutional midwifery for the Borough as a whole was 38.14 per cent., the figures for the various districts being: Woolwich, 42 per cent. ; West Plumstead, 38 per cent.; East Plumstead, 38 per cent.; and Eltham, 35 per cent. The number of maternity beds in the Borough is not yet equal to the demand, and I have little doubt that the provision of further beds would mean a further increase in the number of women entering institutions for their confinements. The following Table, No. 8, shews the number of corrected births each year since 1923, the number of live and still 19 births notified, the percentage of notified births, and the birth rates for the same period for Woolwich, London and England and Wales. TABLE No. 8. Year. No. of births. No. of live births notified. No. of still births. Percentage of births notified. Birth Rate. Woolwich. London. England and Wales. 1923 2867 2864 93 97 20.5 20.2 19.7 1924 2590 2588 84 97 18.5 18.7 18.8 1925 2582 2612 76 99 18.3 18.0 18.3 1926 2463 2442 68 95 17.4 17.1 17.8 1927 2242 2366 62 100 15.9 16.1 16.7 MARRIAGES. There were 977 marriages (1,136 in 1926). The marriage rate was 13.9, as compared with 16.9, 15.7, 15.06 and 16.01 in the four preceding years. DEATHS. The total deaths registered in the district were 1,214. This figure includes 82 non-residents who died in the district but does not include 359 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,491 is obtained. The death rate for the year was 10 6. In 1926 the corresponding rate was 102. Accordinging to the figures published by the Registrar General for the 52 weeks ending 31st December, 1927, no metropolitan borough had a lower rate than Woolwich. This is an improvement on 1926, when Woolwich took second place amongst metropolitan boroughs. 20 In 1927, the death rate for England and Wales was 12.3, and for London, 11.9. The mean death rate for the 107 great towns was 12.2. The following Table, No. 9, shews the death rates in each registration district (after correction for outward and inward transfers) for each year since 1923:— TABLE No. 9. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 1923 12.2 10.5 9.7 6.9 9.9 1924 13.9 11.5 10.1 8.5 11.0 1925 13.6 11.6 9.7 8.2 10.8 1926 11.7 11.1 10.3 7.6 10.2 1927 13.0 11.4 9.9 8.3 10.6 The seasonal mortality in the four quarters of the year was as follows : First quarter, 15.3; second quarter, 9.2; third quarter, 7.8; fourth quarter, 9.7. Deaths in Public Institutions. In tabular form is shewn below the number of deaths of Woolwich residents which took place in various institutions during the year:— TABLE No. 10. Number of Deaths. Hospitals or Institutions. Poor Law Institutions 492 London General Hospitals 82 Mental Hospitals 36 Special Hospitals 56 Infectious Diseases Hospitals 24 Tuberculosis Institutions 25 Cottage Hospitals and Nursing Homes 16 The following Tables are self-explanatory. 731 21 TABLE No. 11. Birth Rate, Death Rate, and Analysis of Mortality during the year 1927. Birth rate per 1,000 Total Population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes Enteric Fever. Small-Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœal and Enteritis (under Two years). Total Deaths under 1 Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. tified Causes of Death. England and Wales 16.7 12.3 0.01 0.00 0.09 001 0.09 0.07 0.57 0.51 6.3 69 91.7 6.6 0.7 1.0 107 County Boroughs and Great Towns, including London. 17.1 12.2 0.01 0.00 0.12 0.01 0.10 0.08 0.49 0.46 8.3 71 91.9 6.6 0.9 0.6 155 Smaller Towns (1921 Adjusted Populations, 20,000.50,000). 16.4 11.3 0.01 0.00 0.07 001 0.08 0.05 0.58 0.41 5.0 68 92.7 5.8 0.3 1.2 London 16.1 11.9 0.01 0.00 0.04 0.01 0.12 0.09 0.39 0.51 7.5 59 90.3 7.9 1.8 0.0 WOOLWICH 15.9 10.6 0.00 0.00 0.01 0.00 0.07 0.07 0.32 0.39 2.2 42 89.7 10.3 0.0 0.0 22 TABLE No. 12. Deaths of Woolwich Residents Registered during the Calendar Year 1927, Classified by Age and Cause. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. All Aces. Under 1 year. I and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and under 75 years. d upwards. All causes 1491 95 21 29 39 71 181 401 321 333 Enteric fever .. .. .. .. .. .. .. .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. 1 .. .. .. .. .. .. Scarlet fever .. .. .. .. .. .. .. .. .. .. Whooping cough 10 3 4 3 .. .. .. .. .. .. Diphtheria 10 .. 1 3 5 .. .. 1 .. .. Influenza 45 2 1 .. 3 2 6 10 11 10 Encephalilethargica 3 .. .. .. .. .. 2 .. 1 .. Meningococcal meningitis .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system 148 .. .. 1 3 40 53 41 9 1 Other tuberculous diseases 30 1 4 3 8 5 7 1 1 .. Cancer, malignant disease 210 .. .. .. .. 1 20 86 68 35 Rheumatic fever 3 .. .. .. 3 .. .. .. .. .. Diabetes 12 .. .. .. .. 1 1 3 5 2 Cerebral hæmorrhage, &c. 96 .. .. .. .. .. 4 26 33 33 23 TABLE No. 12.—continued. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and under 75 years. d upwards. Heart disease 211 .. .. .. .. 3 15 76 65 52 Arterio-sclerosis 38 .. .. .. .. .. .. 14 10 14 Bronchitis 114 10 1 1 1 .. 4 18 29 50 Pneumonia (all forms) 94 8 7 10 2 5 14 20 17 11 Other respiratory diseases 10 .. .. .. .. .. 1 5 1 3 Ulcer of stomach or duodenum 11 .. .. .. .. .. 4 4 1 2 Diarrhœa, &c. 6 5 .. 1 .. .. .. .. .. .. Appendicitis and typhlitis 6 .. .. 2 1 2 1 .. .. .. Cirrhosis of liver 6 .. .. .. .. .. .. 4 1 1 Acute and chronic nephritis 46 .. .. 1 .. .. 6 19 14 6 Puerperal sepsis 3 .. .. .. .. .. 3 .. .. .. Other accidents and diseases of pregnancy and parturition 3 .. .. .. .. .. 3 .. .. .. Congenital debility and malformation, premature birth 49 49 .. .. .. .. .. .. .. .. Suicide 17 .. .. .. .. .. 2 9 5 1 Other deaths from violence 55 2 2 6 5 12 9 5 14 Other defined diseases 254 15 1 3 7 7 23 55 45 98 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. 24 TABLE No. 13. Shewing the Nett Deaths of Woolwich Residents, all Deaths occuring in Institutions in the Borough and Death of Woolwich Residents occuring in Institutions outside the Borough, during the year 1927. Causes or Death. Males. Females. Woolwich.. Plumstead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. NonResidents. All causes 784 707 405 449 347 290 406 65 325 Enteric fever ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... Measles ... 1 1 ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... Whooping cough 3 7 5 3 ... 2 ... ... 5 Diphtheria 6 4 4 2 3 1 ... ... 9 Influenza 26 19 14 13 6 12 12 2 5 Encephalitis lethargica 3 ... ... 1 ... 2 ... ... 3 Meningococcal meningitis Tuberculosis of respiratory ... ... ... ... ... ... ... ... ... system 87 61 35 50 36 27 42 4 41 Other tuberculous diseases 16 14 7 10 3 10 8 ... 11 Cancer, malignant disease . 101 109 58 65 53 34 48 11 57 Rheumatic fever 1 2 2 ... 1 ... 1 ... 1 Diabetes 5 7 3 5 3 1 7 ... 2 Cerebral haemorrhage, &c. 46 50 28 26 23 19 41 6 10 25 TABLE No. 13.—continued. Causes of Death. Male. Female. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. NonResidents. Heart disease 106 105 62 66 55 28 63 7 24 Arterio-sclerosis 20 18 10 7 10 11 4 ... 13 Bronchitis 56 58 35 34 29 16 11 3 11 Pneumonia (all forms) 56 38 32 27 21 14 32 5 12 Other respiratory diseases 5 5 1 5 2 2 3 ... ... Ulcer of stomach or duodenum 8 3 2 2 3 4 ... 1 5 Diarrhoea, &c. 3 3 3 ... 2 1 2 ... 2 Appendicitis and typhlitis 1 5 1 3 1 1 4 ... 2 Cirrhosis of liver 6 ... 1 2 1 2 1 ... ... Acute and chronic nephritis 15 31 9 15 12 10 8 l 10 Puerperal sepsis • •• 3 2 ... ... 1 ... ... 3 Other accidents and diseases of pregnancy and parturition ... 3 ... 1 1 1 1 ... 1 Congenital debility and malformation, premature birth 30 19 14 12 14 9 13 1 10 Suicide 11 6 3 8 4 2 5 ... ... Other deaths from violence 34 21 17 13 7 18 16 8 19 Other defined diseases 139 115 56 79 57 62 84 16 69 Causes ill-defined or unknown ... ... ... ... .. ... ... ... ... 26 CAUSES OF DEATH. Table No. 12 shews that there were 211 deaths from heart disease, 210 from cancer, 148 from pulmonary tuberculosis, 114 from bronchitis, 96 from cerebral haemorrhage, 94 from pneumonia, and 45 from influenza. 71 per cent. of all deaths occurred in persons over 45 years of age. Tuberculosis and Infectious Fevers. These are referred to in the section dealing with the notifiable infectious diseases. Respiratory Diseases. The following Table, No. 14, shews the number of deaths each year since 1923 from respiratory diseases, the annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age. TABLE No. 14. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. No. under 5 years. Percentage under 5 years. 1923 93 65 10 168 1.2 22 13.1 1924 142 95 10 247 1.8 65 26.3 1925 110 97 16 223 1.6 47 21.1 1926 103 81 13 197 1.4 35 17.8 1927 114 94 10 218 1.5 37 17.0 Heart Disease. The deaths from heart disease, which numbered 191 in 1926, numbered 211 in 1927. In that year, all except 18 were in persons over 45 years of age. 27 Diarrhoea. Six deaths were certified as due to diarrhoeal diseases, and 5 of these occurred in children under 2 years of age. In 1926, the figures were 17 and 13 respectively. Maternal Mortality. In England and Wales the deaths of mothers from diseases primarily due to child bearing approximate to four maternal deaths to every 1,000 live births, and this figure has been more or less constant for over 20 years. In 1927, six deaths in the Borough were due to these groups of diseases, a figure below the average of the last five years. The following Table shows the causes of death each year since 1912. 28 TABLE No. 15. Maternal Mortality, Woolwich, 1912-1927. Year. Abortion. Ectopic Gestation. Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia. Puerperal Phlebitis and Embolism. Puerperal Fever. Totals. 1912 1 - - - - - 1 1 1 4 1913 1 - - - 1 - 1 - 2 5 1914 1 - 1 2 - 1 1 1 4 11 1915 1 1 - - 1 - 2 - 3 8 1916 - 1 1 1 4 - 1 - 7 15 1917 - 1 - 2 - 1 2 1 7 14 1918 1 - - 2 1 - 1 1 9 15 1919 - 2 1 2 - - 2 1 5 13 1920 - 1 - - 1 - 1 3 5 11 1921 - - - - - - 3 2 5 10 1922 - - - 1 - - 2 - 3 6 1923 - - - - 1 - 1 - 3 5 1924 - - 2 1 1 - 3 1 2 10 1925 - - 1 2 1 1 1 - 3 9 1926 - 1 - 2 - -- 1 2 6 1927 - 1 - - - - 1 1 3 6 Totals 5 8 6 15 11 3 23 13 64 148 29 Violence and Suicide. Fifty-five deaths (34 males and 21 females) occurred from violence, apart from suicide, a number somewhat in excess of previous years. Seventeen deaths were due to suicidal causes, 11 males and 6 females. Cancer. The total number of deaths was 210, of which 101 occurred in males and 109 in females. Deaths certified as due to cancer or malignant disease each year since 1923 are shewn in Table No. 16, and it will be noted that the death rate from this disease has never been so high. TABLE No. 16. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1923 91 84 175 1.25 12.62 1924 87 94 181 1.29 11.73 1925 83 110 193 1.37 12.71 1926 93 104 197 1.39 13.59 1927 101 109 210 1.49 14.08 The following Table, No. 17, shews the seat of primary disease in all deaths from cancer (including all other specified malignant tumours). 30 TABLE No. 17. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Tongue 1 - 1 - Mouth and Jaw 5 1 6 4 Pharynx 3 - 3 2 (Esophagus 2 2 4 2 Stomach 26 24 50 26 Liver and Gall Bladder 7 12 10 2 Intestines 9 10 19 12 Rectum 7 5 12 6 Uterus - 14 14 10 Ovary - 4 4 3 Breast - 25 25 8 Vagina and Vulva - 2 2 2 Skin 7 - 7 3 Larynx 6 - 6 3 Lung 2 2 4 3 Pancreas 2 1 3 3 Neck 1 - 1 1 Bladder 10 3 13 8 Other specified Organs 5 - 5 1 Other and undefined — 2 2 — Sarcoma 8 2 10 6 101 109 210 105 Inquests. There were 154 inquests held on Woolwich residents during the year, compared with 147 in 1926 and 141 in 1925. DEATHS OF CHILDREN 1—5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 21, and between 2-5, 29. In 1926 these figures were 26 and 32, respectively. The causes of death are given in detail in Table No. 12. Below are set out Tables shewing the variation in the rates of mortality in these age groups in five-yearly periods since 1911 and for the years 1926 and 1927. 31 TABLE No. 18. Child Mortality (1.2 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 1911.1915 2,581 7 .67 2.87 8.76 2.56 4.96 26.82 1916.1920 2,536 6.86 1.42 8.28 .63 4.42 21.61 1921.1925 2,876 3.69 1.46 4.52 .49 2.99 13.15 1926 2,438 3.69 .41 3.69 1.64 1.23 10.66 1927 2,348 2.13 1.70 3.41 . 1.70 8.94 TABLE No. 19. Child Mortality (2.5 years). Death Rates for 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 1911.1915 7,681 3.05 1.20 1.56 .26 1.30 7.37 1916.1920 7,547 2.70 1.09 1.54 .02 2.52 7.87 1921.1925 8,266 1.79 .61 .77 .22 1.23 4.62 1926 7,794 1.29 .51 .89 - 1.41 4.10 1927 7,476 .94 .54 1.47 .13 .80 3.88 32 INFANTILE MORTALITY. The number of deaths under one year was 95, compared with 107 in 1926 and 141 in 1925. The infantile mortality rate (deaths under one year per 1,000 births) was 42, compared with 43 in 1926 and 55 in 1925. This is the second lowest rate in London—Holborn being first with 38—and is the lowest figure ever recorded in the Borough. This year's figures shew that the infantile mortality rate, which a little over a decade ago was in the 80's, is now steadying in the 40's. The infantile mortality rate for the administrative county was 59. The following Table, No. 20, shews the infantile mortality rate in the Borough and registration districts for each year since 1923. The following Table, No. 20, shews the infantile mortality rate in the Borough and registration districts for each year since 1923. TABLE No. 20. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 1923 51 37 42 39 43 1924 79 42 68 70 65 1925 59 42 51 69 55 1926 51 37 41 44 43 1927 53 29 42 47 42 Causes of Death. The chief cause of death was premature birth, 36 deaths out of 95 being certified as due to this cause. Ten deaths were due to Bronchitis, 8 to Pneumonia, and 7 to Debility or Marasmus. Three deaths occurred from Whooping Cough and one from Chicken Pox. The neo-natal mortality rate, i.e., deaths under 4 weeks, was 22.75, 33 pared with 22.33 in 1926, which was the lowest figure ever recorded. Of 51 neo-natal deaths, 33 were certified as due to premature birth. Deaths of Illegitimate Children. The number of deaths of illegitimate infants was 2. A comparison of the infantile mortality rates of legitimate and illegitimate infants shews that the rate for legitimate was 43, and for illegitimate 30. These figures are somewhat unusual. For the purpose of record, Tables are set out in the following pages which classify in various ways, by sex, by age and by district, the causes of death during 1927. In addition, Table No. 24 has been constructed to shew the death rate from stated groups of diseases in each five-yearly period since 1901, and a comparative study of the causes of death in the three years in which the infantile death rate was lowest, namely, 1923, 1926 and 1927. c 34 TABLE No. 21. INFANT MORTALITY, 1927. Nett Deaths from stated Causes at various Ages under One year of age. Causes of Deaths. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1 month and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. 1 1 Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 .. 1 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous .. .. .. .. .. .. .. 1 1 2 Convulsions .. .. .. .. .. .. 1 .. 2 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 1 2 2 2 3 1 10 Pneumonia (all forms) .. .. .. .. .. .. .. 6 2 8 Diarrhoea .. 1 .. .. 1 .. .. .. .. 1 Enteritis .. .. .. .. .. 1 1 .. 2 4 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 5 .. .. .. 5 .. .. .. .. 5 Congenital Malformation 4 .. .. .. 4 .. 2 .. .. 6 Premature Birth 27 3 3 .. 33 2 1 .. .. 36 Atrophy, Debility and Marasmus 2 1 .. 1 4 3 .. .. .. 7 Other Causes 1 1 .. .. 2 1 .. 2 3 8 39 6 4 2 51 9 9 12 14 95 Nett Births registered during the calendar year Legitimate Illegitimate 2175 67 Illegitimate Nett deaths registered during the calendar year Legitimate Illegitimate 93 2 35 TABLE No. 22. INFANT DEATHS, 1927. Causes of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. M. F. M. F. M. F. M. F. M. F. Smallpox .. .. .. .. .. .. • • .. .. .. Chickenpox .. 1 .. .. .. .. .. 1 .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 2 1 .. 1 .. .. .. .1 .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 1 .. .. .. .. .. .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) 1 1 .. .. .. .. .. .. .. 1 Convulsions 1 2 .. .. .. .. .. .. 1 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 7 3 2 3 4 .. .. .. 1 .. Pneumonia (all forms) 2 6 .. 2 .. 1 1 2 1 1 Diarrhoea .. 1 .. .. .. .. .. 1 .. .. Enteritis 2 2 1 1 .. .. .. 1 l .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at birth .. .. .. .. .. .. .. .. .. .. Atelectasis 3 2 2 .. 1 .. .. 1 .. 1 Congenital Malformation 5 1 1 .. 1 .. 1 .. 2 1 Premature birth 23 13 6 5 7 2 6 4 4 2 Atrophy, Debility and Marasmus 2 5 1 2 1 .. .. 3 .. .. Other causes 4 4 2 2 .. .. .. .. 2 2 52 43 16 16 15 3 8 13 13 11 T 95 32 T 18 21 t 24 36 TABLE No. 23.-INFANT DEATHS, 1927. Causes of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. Under 4 weeks. 4 weeks— 1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. 1 .. .. .. .. .. 1 .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. 3 .. 2 .. .. .. .. .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 1 .. .. .. .. .. .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. . .. .. .. .. .. .. Meningitis (not Tuberculous) .. 2 .. .. .. 1 .. .. .. 1 Convulsions .. 3 .. .. .. .. .. .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 2 8 1 4 1 3 .. .. .. .. Pneumonia (all forms) .. 8 .. 2 .. 1 .. 3 .. 2 Diarrhoea 1 .. .. .. .. . . 1 .. .. .. Enteritis .. 4 .. 2 .. .. .. 1 .. 1 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 5 .. 2 .. 1 .. 1 .. 1 .. Congenital Malformation 4 2 1 .. .. 1 1 .. 2 1 Premature Birth 33 3 10 1 9 .. 10 .. 4 2 Atrophy, Debility & Marasmus 4 3 2 1 1 .. 1 2 .. Other causes 2 6 2 2 .. .. .. .. .. 4 51 44 18 14 12 6 14 7 7 17 95 32 18 21 24 37 TABLE No. 24. INFANT MORTALITY, 1901.1927. Rates for stated groups of diseases and for stated age periods for the quinquennial periods 1901.1927. Period. Groups. Totals. Sub.Division of Group 'G.” Death Kates. A B C D E F G H Infectious Diseases. Tuberculous Diseases. Diseases of Nervous System. Diseases of Respiratory System. Diseases of Digestive System. Syphilis. Diseases of Development. All other Diseases. Congenital Defects. Prematurity. Debility. Under 4 weeks. Over 4 weeks 1901.1905 7.26 4.33 8.48 19.30 24.62 .94 44.14 10.76 119.83 - - - - - 1906-1910 6.75 3.41 6.81 17.50 14.39 1.58 38.50 8.58 97.52 6.81 19.95 11.74 37. 50 60.02 1911-1915 5.04 2.55 4.19 17.10 13.77 106 31.99 10.64 86.34 3.12 18.30 10.57 32.27 54.07 1916-1920 4.08 1.09 3.53 16.30 7.74 1.29 33.67 10.92 78.62 3.19 19.96 10.52 35.44 43.18 1921-1925 3.81 1 .55 2.82 10.52 6.13 •70 23.07 8.75 57.35 4.30 12.84 5.93 25.47 31.88 1923 1.39 0.35 3.49 5.23 2.79 0.35 21.97 7.33 42.90 3.48 14.30 4.19 25.11 17.79 1926 1.62 1 .62 1.22 7.71 3.65 0.41 19.90 7.31 43.44 3.25 12.99 3.66 22.33 21.11 1927 1.79 0.45 2.23 8.03 2.23 - 21.85 5.80 42.38 2.67 16.06 3.12 22.75 19.63 The rates in each case are per 1,000 births. 38 SECTION III.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. It is laid down by the Ministry of Health that, in Annual Reports for 1927, there shall appear a statement regarding the general provision of health services in the area. In the case of a metropolitan borough, such a statement must of necessity be incomplete because many of the inhabitants no doubt seek medical assistance from institutions outside the area, and many of the services which have their origin in the work of the Health Department pass from that to general county services. Most of the matter which is dealt with here will be referred to in detail in succeeding sections of the report, and so references are given to the pages where the details are to be found. The information given here is more or less in precis form. i. Hospitals provided or subsidised by the Local Authority or by the County Council. (a) Fever and (b) Smallpox. Fever hospitals in the metropolis are under the control of the Metropolitan Asylums Board and, although there are no hospitals in Woolwich, there are several within easy reach. In actual fact, most of the Woolwich cases are admitted to the Brook Hospital in Greenwich, the Park Hospital in Lewisham, or Joyce Green Hospital, near Dartford. Detailed information regarding the use made of the Asylums Board's Hospitals by Woolwich residents is set out in Table No. 44. in the section dealing with the Prevention and Control of Infectious Diseases. A small number of infectious cases are admitted to the London Fever Hospital, an institution where fever patients are received on payment, either in general or private wards. 39 (c) Tuberculosis. The arrangements for the treatment of Tuberculosis are discussed in Section VII. of the report. The London County Council are responsible for the provision of institutional treatment for persons suffering from Tuberculosis in London. (d) Maternity. The British Hospital for Mothers and Babies was opened in its extended form in 1922. Thirty-four beds are provided and from the information available in the birth returns, it would appear that approximately 79 per cent. of the admissions are Woolwich cases. Detailed information regarding this institution will be found on page 138. (e)Children. There is no special hospital for children in the Borough. (/) Others. At the present time there are no other hospitals in Woolwich maintained or subsidised by the local authority or the London County Council, but a new general hospital— the Woolwich War Memorial Hospital—was formally opened by their Royal Highnesses the Duke and Duchess of York in November, 1927, and will be receiving patients early in the new year. The Council have entered into an arrangement with the Governors whereby accommodation is reserved for the treatment of children under five years of age and for maternity cases, including emergency provision for ante-natal cases. These arrangements have been approved by the Ministry. ii. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the Area. Detailed information regarding the Woolwich and Plumstead Maternity Home will be found on page 139. iii. Ambulance Facilities. (a) The Metropolitan Asylums Board's ambulance service is available for the removal to hospital, free of charge, of persons suffering from infectious disease, and, on payment, for the removal of persons to hospitals or homes. 40 (b) The ambulance service of the London County Council is available for the removal of cases of accident and sudden illness arising in the streets or public buildings, and for the removal of ordinary maternity cases between the hours of 11 p.m. and 8 a.m., and urgent maternity cases during the day time when accompanied by a doctor or a nurse. iv. Clinics and Treatment Centres. In tabular form below is shewn a list of clinics and treatment centres in the Borough. The list differs in two items from that of last year, viz., the substitution of the Council's new welfare centre at the Old Town Hall in place of the premises at the Town Hall, and also by the inclusion of a Sunlight clinic. Details regarding the work of the maternity centres will be found on pages 128 to 135, and with regard to Tuberculosis on pages 117 to 120. Persons requiring treatment for venereal diseases can attend one of the London hospitals, the nearest to the Borough being the Seamen's Hospital, Greenwich, and St. John's Hospital, Lewisham. TABLE No. 25. CLINICS AND TREATMENT CENTRES. Situation. Nature of Accommodation. By whom provided. Sessions weekly. Maternity and Child We Ifare Centres. Old Town Hall, Woolwich. Doctor's room, Weighing room, Waiting rooms, etc. Woolwich Borough Council 6 236, Plumstead High Street. Do. Do. 6 179, Well Hall Road, Eltham. Do. Do. 4 Wesley Hall, Timbercroft Lane, Plumstead. Doctor's room, Weighing room. Do. 2 41 TABLE No. 25—-continued. Situation. Naturo of Accommodation. By whom provided. Sessions weekly. Tenants' Hall, New Eltham. Doctor's room, Weighing room. Do. 1 St. John's Hall. North Woolwich. Do. Do. 1 Victory Club, Beresford Street. Doctor's room, Weighing room, Waiting room. Voluntary Organisation 1 Sunlight Clinic. Old Town Hall, Woolwich. Treatment and Weighing rooms, etc. Woolwich Borough Council. 9 Day Nurseries. Nil. School Clinics. Brewer Street, Woolwich. Doctors' rooms, Treatment rooms, Waiting rooms. Local Medical Association. Daily Plumstead Road, Plumstead. Do. Do. Daily. Cyril Henry Treatment Centre, St. Mary Street, Woolwich. Accommodation for operating on, and detention of, cases of enlarged tonsils and adenoids. London County Council. Daily. Borough Disinfecting Station, White Hart Road, Plumstead. Accommodation for cleansing of verminous children. Woolwich Borough Council. Daily. Tuberculosis Dispensary. Maxey Road, Plumstead. Doctors' rooms, Waiting rooms, Dressing rooms, Dispensarv. etc. Do. Daily. Venereal Diseases. Nil. 42 v. Public Health Officers of the Local Authority. In tabular form is shown below the names, qualifications, service and duties of the members of the public health staff. Two changes took places during the year—Dr. N. Maclennan resigned on appointment to the Colonial Medical Service, and a new appointment of a Sunlight Clinic nurse was made. The officers appointed were Dr. C. I. Wright and Miss E. V. Farrell. TABLE No. 26. Year appointed. Name. Qualifications. Appointment. †1918 Mackenzie, R. E. W. M.B., D.P.H Assistant Medical Officer of Health for Maternity and Child Welfare. †l921 Blackmore, F. J. C. M.R.C.S., L.R.C.P Assistant Medical Officer of Health and Tuberculosis Officer. †l927 Wright C. I. M.D., B.S., D.P.H. Assistant Medical Officer (General Purposes).* 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D.,F.R.S.(Edin.) Public Analyst (Part time) *1890 Duck, A. G. F.S.I.A., Cert. Royal San.Inst., Cert. Meat and other foods. Chief Sanitary Inspector. *1896 Little, W. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1897 Wood, W. Cert. Royal San. Inst. Sanitary Inspector. *1901 Tedham, W. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1904 Powell, T. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1909 Shaw, H. Cert. Royal San. Inst., Cert.San.Insp.Exam. Board, Cert. San. Insp. Assocn., Cert. Meat and other foods. Sanitary Inspector. 43 TABLE No. 26—continued. Year appointed. Name. Qualifications. Appointment. *1920 Pendrill, H. W. Cert. San. Insp. Exam. Board, Cert. Meat and other foods. Sanitary Inspector. *1921 Harris, C. V. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1922 Couch, C. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1925 Pindar, E. B. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1904 Farrugia., Mrs. A. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst. Woman Sanitary Inspector. †1917 Latham, Miss K. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., C.M.B. Health Visitors'Cert., Cert, approved by Board of Education. Health Visitor. *†1918 Garside, Mrs. M. Cert. San. Insp. Exam. Board,C.M.B.,Health Visitors' Certificate. Health Visitor and Sanitary Inspector. +1919 Burnett, Miss W. . . Cert. San. Insp. Exam. Board, C.M.B.Health Visitors' Diploma, Cert, approved by Board of Education. Health Visitor. +1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors' Diploma, Cert, approved by Board of Education. Health Visitor. *†l919 Ware, Miss C. Cert. San. Insp. Exam. Board, C.M.B. Cert., approved by Board of Education. Health Visitor and Sanitary Inspector. †1920 Campbell, Miss M. Cert. General Hospital Training, C. M. B., Cert.San.Insp. Exam. Board. Health Visitor. 44 CLERKS : Britter, A. Prescott, H. T. Collyer, H. M. Smith, H. S. †Edwards, Mrs. E. †Stephenson, Miss D. Pike, L. Taylor, S. G. MORTUARY KEEPER: F. Leason. The Medical Officer of Health* is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. * Salary contributions made under Public Health Acts. †Salary contributions made by Exchequer Grants. TABLE No. 26—continued. Year appointed. Name. Qualifications. Appointment. †1920 Morgan, Miss F. Cert. General Hospital Training, C. M. B. Health Visitors' Cert. Maternity and Child Welfare Cert. Health Visitor. †1922 Seccombe, Miss W. Cert. General Hospital Training, C. M. B., Health Visitors' Cert. Health Visitor. †1927 Farrell, E. V. Cert. General Hospital Training, Cert. approved by Board of Education, C.M.B., Heliotherapy Cert. Health Visitor and Artificial Sunlight Clinic Nurse. †1921 Castledine, Mrs. L. Cert. General Hospital Training. Tuberculosis Visitor. † 1921 Hunter, Miss M. Cert. San. Insp. Exam. Board,C.M.B.Health Visitors' Diploma. Tuberculosis Visitor. † 1921 Mahoney, Miss N. Cert. General Hospital Training, Health Visitors' Cert. Tuberculosis Visitor. †1923 Luffman, Miss M. Dispensing Certificate Clerk-Dispenser. †1922 Morrison, Mrs. M. L. — Lay Organiser. 46 vi. Professional Nursing in the Home. During the year nursing assistance was available in all parts of the Borough. Such assistance is provided by four Nursing Associations, as follows :— Woolwich and Plumstead District Nursing Association : All Woolwich (except North Woolwich) and Plumstead. Silvertown and North Woolwich District Nursing Association : North Woolwich. Eltham Provident Nursing Association : All Eltham (except New Eltham). New Eltham Nursing Association : New Eltham. All these Associations insist that the patient shall be under the care of a medical practitioner and, in ordinary circumstances, only nurse non-infectious cases. On the recommendation of the Medical Officer of Health, however, they provide nursing assistances for cases of Measles, Whooping Cough, Zymotic Enteritis, Ophthalmia Neonatorum, Tuberculosis, Anterior Poliomyelitis, Puerperal Fever and Puerperal Pyrexia. For these diseases the Borough Council pay, in necessitous cases, in accordance with the following schedule :— Disease. Measles Ophthalmia Neonatorum. Zymotic Enteritis Whooping Cough Poliomyelitis Pneumonia and Influenzal Pneumonia Puerperal Fever Puerperal Pyrexia Rate of Payment. 1s. per visit for one case ; 6d. per visit, per case, for more than one case in the house at the same time. 1s. 3d. per visit. 46 vii. Midwives. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 41 midwives gave notice during the year of their intention to practise as midwives in the Borough. viii. Chemical Work. The Public Analyst is Sir. W. R. Smith, who carries out the laboratory work of the Council at the Royal Institute of Public Health. Detailed results of the analyses made will be found in Tables Nos. 37 to 40 in the section dealing with the inspection and supervision of food. ix. Bacteriological Examinations. These are carried out at the Seamen's Hospital, Greenwich. In tabular form is shewn below the number and result of the various examinations made during the year. For comparative purposes the figures for 1926 are also given : TABLE No. 27. Disease. Positive Result. Negative Result. Total 1927. Total 1926. Diphtheria 140 1,178 1,318 1,206 Enteric Fever . . 3 18 21 18 Tuberculosis 74 317 391 307 217 1,513 1,730 1,551 x. Adoptive Acts, By-laws and Regulations relating to Public Health in force in the District. Adoptive Acts. The Small Dwellings Acquisition Acts, 1899-1923, have been adopted by the Council. During 1927, the Borough Treasurer tells me, the Council made 294 advances to purchasers of houses in accordance with the provisions of these Acts. 47 The following is a list of By-laws and Regulations made under the various Acts, with dates of adoption :— By-laws made under :— Public Health (London) Act, 1891. Section. Date of Adoption. 16 (1) Prevention of nuisances arising from matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces. l5th May, 1903 16 (2) Closing of cesspools and privies : Removal and disposal of refuse. 28th June, 1893 16 (2) Removal of faecal and offensive matter. 26th Nov., 1901 39 (1) Construction of closets, privies, ashpits, cesspools, and dung receptacles 28th June, 1893 14th June, 1901 3rd Jan., 1905 39 (2) Keeping water closets supplied with sufficient water. 24th June, 1903 45 Decent conduct of persons using public lavatories, etc. 24th June, 1903 50 Securing cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water. 24th June, 1903 88 Management of Mortuaries 24th June, 1903 95 Tents, Vans, Sheds 24th June, 1903 19 Bone boiler, Manure manufacturer or Tallow melter. 25th Nov., 1907 19 Gut scraper and Catgut maker or Catgut manufacturer. 25th Nov., 1907 48 Section. of Adoption. 19 Fat Melter or Fat Extractor 25th Nov., 1907 19 Fellmonger 25th Nov., 1907 19 Dresser of Fish Skins 25th Nov., 1907 19 Dresser of Fur Skins 22nd Mar., 1922 19 Glue and Size Manufacturer 25th Nov., 1907 19 Knacker 25th Nov., 1907 19 Slaughterer of Poultry 22nd Dec., 1923 19 Soap Boiler 25th Nov., 1907 19 Tripe Boiler 25th Nov., 1907 London County Council (General Powers) Act, 1908 :— 9 Rag and Bone Dealer 18th Sept., 1923 9 Fish Curer 28th Feb., 1914 9 Vendor of Fried Fish 28th Feb., 1914 London County Council (General Powers) Act, 1902 :— 53 Common Lodging Houses 14th Aug., 1903 London County Ccuncil (General Powers) Act, 1903 :— 54 Conveyance of Carcases of dead horses through public streets. 21st Feb., 1905 Metropolis Management Act, 1855 :— 202 Drains, regulating dimensions of, keeping, cleansing and repairing of. 14th June. 1901 Metropolis Management Act. 1855 (Section 202) and Metropolis Management Acts (Amendment—By-laws) Act. 1899— 49 Section. Date of Adoption. Plans to be deposited. Construction, re- 20th Aug., 1903 construction, or alteration of pipes, drains, traps, and other apparatus. Slaughterhouse, etc. (Metropolis) Act, 1874 and the Local Government Act, 1888 :— Slaughterer of Cattle 27th Oct., 1891 Baths and Washhouses Act, 1846 :— 34 Management, Use and Regulations 24th June, 1903 of Public Baths. Public Health Act, 1875 :— 167 Regulating the use of the Market 24th June, 1903 place. Regulations made under :— Factories and Workshops Acts and Public Health (London) Act, 1891 :— Bakehouses 31st Jan., 1902 Housing, Town Planning, etc., Act, 1909 :— 17 (7) Underground Rooms 9th Feb., 1911 Public Health (London) Acid: Housing Act, 1925:— Houses divided into separate tenements, etc. 5th Mar., 1926 Section 55 of the Public Health (London) Act, 1891, has been applied to Zymotic Enteritis. d 50 xi. Health Week. The Council co-operated in the autumn in the general scheme of health propaganda throughout the country, organised by the Health Week Committee. The following report, presented by the Public Health Committee to the Council, gives details of the week's programme. " In accordance with the Council's resolution of the 2nd March, 1927, we arranged a suitable programme for Health Week, 1927. In this we were fortunate in securing the co-operation of the Electricity and Libraries Committees. We commenced the Week by opening the new Maternity and Child Welfare Centre and Artificial Sunlight Clinic, at the Old Town Hall, Woolwich, and arranged that these premises should be available for public inspection on each day after the opening between 3 and 9 p.m. At the Old Town Hall also, we organised a Tuberculosis Exhibition, which illustrated the Council's work in connection with Tuberculosis. In this we were assisted by the Dental Board, who lent us a very fine teeth exhibit ; by the Metropolitan Asylums Board, who lent us an orthopaedic exhibit in connection with their work at the Queen Mary Hospital, Carshalton ; by the Seamen's Hospital Society, which shewed pathological specimens ; by the Central Fund for the Industrial Welfare of Tuberculous Persons, who arranged for daily demonstrations of work by cured tuberculous patients ; and by Dr. J. Walker, who sent demonstrators to exhibit the work done at Naylands Sanatorium. We also have to acknowledge the assistance of many others for the loan of smaller exhibits. The Electricity Department gave excellent demonstrations of the domestic use of electricity, a feature which proved exceedingly popular. The Libraries Committee co-operated by exhibiting a selection from the various books on health which can be obtained from the Public Libraries. At the Town Hall we concentrated on health talks, making as much use as possible of health films, and arranged .->1 for the production of a health play, written by a member of the staff of the Department. This play, ' The Sins of the Mother,' was presented by members of the 'Shornells' Dramatic Group on three occasions, and was excellently produced and acted and proved exceedingly popular. This play is a great asset for Health Weeks and Exhibitions, for it illustrates the use that should be made of the sanitary inspector's advice and other resources of local health authorities. The lectures reflected various aspects of health work and were given by experts in their special subjects. A new feature this year was a series of lectures, illustrated by films, for youths. These lectures, which were given in the Council Chamber, were very well received and are worthy of further development in future health weeks. The pictures also illustrated health work, and while certain of these films were hired, others were kindly lent by the Ministry of Health, the Health and Cleanliness Council, the Dental Board of the United Kingdom, the Anglo-American Oil Co., the Bermondsey Borough Council, the Milk Publicity Council, the King Edward Hospital Fund, the Mutual Property Insurance Co., the Lord Mayor Treloar Cripples' Home, the National League for Health, Maternity and Child Welfare, and the National Baby Week Council. Special arrangements were made for the attendance of school children over the age of 13 years at special sessions, when dental films were shewn and a talk given on the care of the teeth by one of the assistant medical officers. We take this opportunity of stating how much we are indebted to the members of the staff and of the other departments of the Council, who assisted us in making arrangements for the opening of the Welfare Centre and Sunlight Clinic ; for the converting of the Town Hall into a suitable building 52 for the shewing of cinema pictures ; for the giving of organ recitals ; for the production of the play : for the preparation of models for exhibition ; for making the stalls attractive, and in many other ways. We are also grateful to the voluntary workers for their assistance in running the creche and in assisting in the welfare centre and at the stalls. To all who helped we have extended, in accordance with the pleasure of the Council, our hearty thanks. The attendance at the Town Hall during the Week was very gratifying, totalling, as in 1926, just short of 10,000. The attendances at the Exhibition and the Maternity Centre and Sunlight Clinic were not recorded, but a noticeable feature of the attendances there was that the daily numbers increased as the Week went on. Our experience this year has demonstrated that there is the same keen desire for information on health matters as was noted in previous years, and it is fair to say that the public interest is increasing, even to the extent that special types of audiences attend individual lectures, e.g., the lecture on Cancer was attended by a much older audience than any other. The success of Health Week could not have been acheived without the united support of the Council and the keen co-operation of the staff and the voluntary workers, and we take this opportunity of thanking all who so contributed for the enthusiasm and energy with which they carried out their share." 53 SECTION IV.—SANITARY ADMINISTRATION. Staff. The sanitary staff consists of a Chief Inspector, seven District Inspectors, one Woman Sanitary Inspector, and two part-time Women Sanitary Inspectors. There are two other Sanitary Inspectors who are wholly engaged in Food and Drugs work and in the supervision of food. Complaints. In accordance with the provisions of the Public Health (London) Act, a complaints book is kept, and all complaints, both written and oral, are recorded there. Inspections are then made by the District Inspectors, who take the necessary steps to ensure the abatement of such nuisances as are found to exist. During the year, 2,589 complaints were received, compared with 2,536 in the previous year. Water Closet Accommodation. A system of sewers exists throughout the Borough, except in the outlying districts, where, as a temporary expedient, cesspools, and earth closets are in use. The number of cesspools regularly emptied by the Council was 26—12 being in Plumstead and 14 in Eltham. Scavenging. Scavenging, which includes the storage, removal and disposal of house refuse and trade refuse, is under the control of the Works Department. With very few exceptions all house refuse is deposited first of all in moveable dustbins, which are emptied once a week, and, in certain parts of the Borough, twice weekly. Electric vehicles are used for the transport of the refuse from its source to the Council's destructor (which has recently been enlarged) at Plumstead. The refuse, before burning, is subjected to a preliminary sorting whereby tins and old iron are removed. These are crushed in a hydraulic press and are sold. The 54 remainder of the refuse is burnt. The clinker is put through a special plant, mixed with bitumen, and then used for surfacing certain classes of roads in the Borough. An arrangement exists whereby the dust inspector notifies the Health Department when dustbins are defective or absent, and immediate action is taken to see that a proper one is supplied. Trade Refuse. The collection of trade refuse is carried out by the Works Department at a charge of 5s. 0d. per load. In order to obtain the removal of trade refuse application must be made at the Town Hall and the charge prepaid. During the year approximately 2,101 loads were removed. Offensive Trade. Refuse. Specially designed receptacles are provided by the Council for this work and a charge of sixpence is made each time a receptacle is used, the full receptacle being removed and a clean empty one substituted. The receptacles are collected daily by means of an electric motor tractor and a closed wagon with sliding doors. The refuse is disposed of to a manufacturer of guano at Poplar and the receptacles are cleansed by steaming and washing. Combined Drains. 14 combined drains, connected with 71 houses, were reported on at various times throughout the year. When it has been ascertained that such a system is choked, investigation is made, and, if the stoppage is only of a temporary character and not due to any defect, the drains are cleared and the fact is recorded. Occasionally it is an economic policy to remedy defects while the examination is being carried out, and, if application is made by the owners at the time, the Council do the necessary work. During the year small repairs, costing in all £1 17s. 6d. were done in this connection, this amount being recovered from the owners concerned. If, however, reconstruction of the whole or of part of the system is necessary, the Council serve notices under the Metropolis Management Act, and in most cases 55 the work is carried out by the Works Department at the expense of the owners. During the year, reconstruction was necessary in one case, involving connections with 10 houses. Sanitary Inspection of the Area. The Sanitary Officer's Order of 1926 defines the duties of sanitary inspectors. Statistical Tables, Nos. 28 and 29, are set out below shewing the number of inspections made and the character and type of the nuisances abated. 3,513 intimation notices and 863 statutory notices were served during the year, compared with 3,819 and 1,344 respectively, last year. The statutory notices related to 709 premises, and included 662 general notices, 136 ashpit, 38 water closet and 27 paving notices served under the Public Health (London) Act. In addition to these, four were served under the London County Council (General Powers) Acts and Bye-laws, and 7 under the Rats and Mice (Destruction) Act, 1919. There were 182 instances in which the owners neglected to comply with the statutory notices, and these were reported to the Town Clerk for legal proceedings. The corresponding figure last year was 226. The Town Clerk followed his usual practice of writing a letter reminding the owner that he was in default in not complying with the requirements of a notice and requesting his attention forthwith. In consequence of these letters, it was found necessary to issue only 17 summonses, details of which are set out in Table No. 31. Nine other summonses were taken out subsequently for non-compliance with the Magistrate's orders. TABLE No. 28. Inspections. 1927. Housing Survey—Houses Inspected 2,594 Complaints Investigated 2,821 Outworkers' Premises 766 56 Houses Let in Lodgings 380 Homes re Verminous Cases 740 Homes re Scabies Cases 167 Overcrowding Investigated—Rooms 130 Underground Rooms illegally occupied 11 Drainage Inspections 311 Drains tested by Smoke Test 126 Drains tested by Water Test 30 New Houses 1,003 Tents and Vans 22 Factories 180 Workshops 588 Workplaces 64 Theatres and Cinemas 29 Rag and Bone Premises 20 Urinals Accessible to the Public 323 Women's Lavatories 307 Smoke Observations 155 Special Inspections re Rats 193 Inspections re Mosquitoes 109 Miscellaneous (unclassified) 1,197 Re-inspections 11,918 TABLE No. 29. Nuisances Abated. 1927. Cleansing— Interiors cleansed 1,466 Rooms cleansed 3,162 Damp Conditions— Walls 771 Sites 2 Roofs 1,097 Rain water pipes and gutters 718 Others 41 57 Dilapidations— Walls 683 Ceilings 465 Floors and Hearths 274 Coppers 153 Stoves 202 Verminous Conditions— Rooms cleansed 236 Defective Lighting— Windows repaired 93 „ enlarged — ,, additional 1 Defective Ventilation— Windows rendered usable 562 „ additional provided 4 Other means 5 Defective Paving— Yards repaved 90 ,, repaired 177 Scullery floors repaved or repaired 121 House Drains— Defective drains repaired 91 Choked drains cleared 197 Vent pipes repaired 10 Soil pipes repaired 12 Gullies fixed 26 New drainage 3 Rain water tanks repaired 17 Sinks repaired or provided 110 Wastes cleansed 87 Wastes trapped or repaired 154 Water Closets— Flushing apparatus repaired 295 „ „ renewed 65 New pans 122 New traps 108 58 Foul plans cleansed by owner 29 ,, ,, occupier 85 Additional w.c.'s provided 4 Doors and fastenings remedied 120 Dustbins provided 1,617 Underground rooms closed 3 Overcrowding—cases remedied 27 Water Supply— Additional Re-instated 22 Cisterns cleansed 5 Cisterns covered 2 Cisterns removed 1 Foul Accumulations Manure removed 76 Offensive accumulations removed 104 Back yards cleansed 71 Rats— Drains repaired in consequence 20 Premises rat-proofed 17 Other effective measures 29 Rag and Bone Premises— Premises cleansed 3 Rain-proof premises provided — Vermin-proof conditions provided — Miscellaneous 19 Rats. All the male sanitary inspectors have been authorised under the Rats and Mice (Destruction) Act, 1919, to act as rat officers in their respective districts and, as in previous years, a good deal of work has been done in this connection in advising occupiers of premises as to the best means for rat-proofing buildings and destroying rats. In Woolwich, we have found that, so far as the small householder is concerned, the most suitable way of trapping rats is by means of the varnish board, although there is still a 59 preference amongst the citizens for some form of trap. During Rat Week in November, the Council co-operated in the general scheme throughout the country. With the assistance of the Works Department, 8,461 baits were laid in manholes of the old sewers likely to be infested, and co-operation was sought from and readily given by many large firms in the Borough. During the year 18 notices were served, but in no instance was it necessary to resort to legal proceedings. Mosquitoes. Very few complaints were received during the year as to nuisance caused to the inhabitants of the lowlying areas of Plumstead and Abbey Wood by the presence of mosquitoes, but, as previously, the mosquito areas were carefully watched during the summer months. There is little doubt that the diminution in these pests is largely, if not entirely, due to the scheme the Council adopted some years ago of improving the drainage of the marsh ditches. Rag Flock. This Act prohibits the use of dirty flock, and the Regulations made thereunder provide for a standard of cleanliness. Five samples were taken during the year, the detailed results of which were as follows :— No. Parts per 100,000 1. Soluble Chlorine in the form of Chlorides 23"5 2. do., do., do. 28.2 3. do., do., do. 18.8 4. do., do., do. 18.8 5. do., do., do. 25.8 All these samples complied with the Rag Flock Regulations, in as much as the amount of soluble chlorine in the form of chlorides did not exceed 30 parts of chlorine in 100,000 parts of flock. Offensive Trades. There are no offensive trades in the Borough. 60 Action taken with Regard to Smoke Abatement. The Sanitary Inspectors in the ordinary course of their duties keep chimney shafts under observation and record any nuisance of smoke in connection therewith. In addition to these, special investigations are made wherever complaints are received and in the course of the year 155 special observations were recorded. Factory and Workshop Act. The Medical Officer of Health is required to include in his Annual Report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register at the end of the year was 258. The number of inspections made was 832, which compares with 877 in 1926. The number of sanitary defects found was 34 and 33 of these were remedied by the end of the year. Bakehouses are specially reported on in the section dealing with the supervision of food. The number of inspections of outworkers' premises was 766, compared with 1,035 last year. Most of the outworkers in the Borough are employed in connection with the manufacture of tennis balls and practically all the remainder are engaged in making wearing apparel. Generally speaking, the homework is carried out under satisfactory conditions, and it was necessary to serve only 8 notices in respect of unwholesome premises. Only one case of infectious disease occurred amongst the outworkers. The following Table is in the form adopted by the Secretary of State to provide for uniformity throughout the country in the presentation of certain particulars of this work which lend themselves to statistical treatment. 61 TABLE No. 30. Factories, Workshops, Workplaces & Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written notices. Prosecutions. Factories (Including Factory Laundries). 180 17 — Workshops (Including Workshop Laundries). 588 10 — Workplaces (Other than Outworkers' Premises) 64 1 — Homeworkers' Premises 766 8 — 2.—Defects Found. Description. Number of Defects. Found. Remedied. Referred to H.M. Inspect'r Number of Prosecutions. Nuisances under Public Health Act :— Want of Cleanliness 6 6 — — Want of Ventilation 3 3 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 7 7 — — Sanitary Acoommodation insufficient 2 I — — unsuitable or defective 15 15 — — not separate for sexes 1 1 — — Offences under the Factory and Workshop Act :— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences — — — — Total 34 33 — — 62 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing apparel :—making, etc. 4 4 — Racquet and tennis balls 4 4 — 8 8 — Legal Proceedings. In Table No. 31 which follows, are set out particulars of the various prosecutions instituted under the Public Heath (London) Act and kindred Acts. TABLE No. 31. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 1927. Jan. 20 Dirty condition of interior and foul w.c. pan. 200, Ancona Road. Work done. Costs 2s. 2 Feb. 10 Defective rain water pipe and arm of w.c. pan. 62, Robert Street Order to abate in 14 days. Costs 4s. 3 do. Dirty top floor front room. 50, Sandy Hill Road. Order to abate in 14 days. 4 April 12 Defective scullery sink. 1, Farm Cottages. Work done. 5 Sept. 1 Choked drain. 15, Nightingale Place. Order to abate in 21 days. Fined £5. 6 do. Defective ceilings and w.c. door. 5, Frederick Place. do. do. 7 do. Defective Roof 31, Frederick Place Order to abate in 28 days. Fined £5. 8 do. Defective Roof 30, Frederick Place. do. do. 63 TABLE No. 31—continued. No. Date of Hearing. Offence. Situation. Result. 9 do. Defective sash cords, rain water pipe and roof. 8, Frederick Place. Order to abate in 21 days. Fined £5. 10 do. Defective ceiling, flooring and rain water pipe- 7, Frederick Place. do., do. 11 do. Defective roof and copper flue. 4, Frederick Place. do., do. 12 do. Leaking house roof and defective and dangerous flooring in passage, kitchen and bedroom. 3, Frederick Place. do., do. 13 do. Water closet dilapidated; guttering defective ; defective roof and sash cords. 2, Frederick Place. do., do. 14 do. Defective roof and copper flue ; defective sash cords. 6, Frederick Place. do., do. 15 do. No dust bin 8, Frederick Place. Fined £2 16 Oct. 6 Defective roof 66, Elm Street .. Work done. Costs 4s. 0d. 17 Nov. 3 Occupied house without a water supply. 31, Frederick Place Closing Order. Fined £5. 18 Nov. 22 Non-compliance with a Magistrate's Order. 2, Frederick Place. Fined £2 14s. 0d. 19 do. do. do. 3, Frederick Place do. 20 do. do. do. 4, Frederick Place do. 21 do. do. do. 5, Frederick Place do. 22 do. do. do. 6, Frederick Place do. 23 do. do. do. 7, Frederick Place do. 24 do. do, do. 8, Frederick Place do. 25 do. do. do. 30, Frederick Place Fined £1 13s. 0d. 26 do. do. do. 31, Frederick Place do. 64 Mortuaries and Cemeteries. In Tables Nos. 32 and 33, which follow, details are given with regard to the Mortuaries and Cemeteries. The information regarding the interments at the Woolwich and Plumstead Cemeteries and the Eltham Churchyard, is given through the courtesy of the Town Clerk and the Vicar of Eltham. Burials in the Plumstead Churchyard are limited by a Home Office Order of 1893, and in each case 24 hours' notice of any proposed interment has to be given to the Medical Officer of Health. The number of interments in this Churchyard is steadily decreasing and the number last year (8) is the lowest yet recorded. When an exhumation licence has been granted, the Medical Officer of Health is notified by the Home Office in order that he may be in a position to take any necessary action in the interests of public health. During the year four copies of such licences were received, and in each case a Sanitary Officer was present at the exhumation. MORTUARIES. TABLE No. 32. Sun Street Sun Street (Infectious) Eltham. All Mortuaries. 1926 1927 No. of Bodies received : (a) for inquest 48 — — 74 48 (6) for custody 6 1 1 18 8 54 1 1 92 56 No. of Post-Mortem Examinations 21 — — 39 21 65 CEMETERIES. TABLE No. 33. Number of Interments 1925. 1926. 1927. Woolwich Cemetery 607 566 554 Plumstead Cemetery 634 688 654 Eltham Cemetery 188 183 200 Plumstead Churchyard 16 15 8 1,445 1,452 1,416 66 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. The inspection and supervision of food becomes more and more important each year, and more and more time of the Sanitary Inspectors is being spent on this work. The district Sanitary Inspectors know that unsound or unfit food may be offered for sale and that premises where food is prepared or sold may not be maintained in a hygienic condition. For these reasons inspection of food and food premises is carried out daily as a routine measure. All food shops and all premises having any association with the preparation of, or sale of, food are under constant supervision. Three inspectors have special duties in connection with this part of the work, devoting regular times to the supervision of the milk supply, the examination of meat, and the sampling of food offered for sale in the shops and markets. Although it can be said that there is a definite improvement in the conditions under which food is prepared, stored and offered for sale, constant reminders are necessary to maintain the improvement. In tabular form below, is shewn the number of inspections made and the number of notices served. Most of the notices dealt with want of cleanliness on the part of traders, their employees, premises or utensils. It was found necessary to serve 73 notices, all of which were complied with. 67 TABLE NO. 34. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 41 101 21 — Cowsheds 22 106 1 — Milkshops 95 677 10 — Ice Cream Shops 136 359 2 — Slaughterhouses 7 25 — — Fried Fish Shops 64 180 16 — Butchers' Shops 92 326 — — Premises where food is prepared (other than above) 140 858 23 — Shops and Markets — 2565 — — MILK SUPPLY. Registration. On 31st December, 1927, there were on the register 95 dairy premises, 23 of which were in Woolwich, 42 in Plumstead, and 30 in Eltham. The number of dairymen or purveyors of milk on the register was 92, but 11 of these carried on their business from registered premises outside the Borough. The number of registered cowkeepers was 8, all, with one exception, being in the parish of Eltham. The changes which took place in the registers were in all instances due to business reasons. Cowkeepers. There are eight registered cowkeepers in the Borough holding licences for 22 cowsheds in all, and providing for 464 cows. The average number of cows kept was 369. These cowsheds are subject to regular inspection 68 and, although, as is shewn in Table No. 34, 106 inspections were made, it was only necessary to serve one notice. Our observations during the year shewed that milk was being produced in the Borough under much better conditions than formerly, and that the cowkeepers and their workers were realising that the production of milk under clean conditions was an asset of much value to them. Dairymen and Purveyors of Milk. Most of the milk sold in Woolwich is produced outside the Borough and comes almost entirely by rail from the milk producing counties. All dairies are inspected monthly and care is taken to ensure that a high standard of purity of the milk is maintained and that cleanliness is observed in connection with the utensils and premises. Most of the milk sold in Woolwich is distributed in bottles and there is evidence that this practice is increasing. The general public like their milk this way and think that because it is delivered in bottles it is clean. Many of the milkmen, unfortunately, do not yet realise that milk is a very fine medium for the multiplication of microbes and do not appreciate the importance of providing an efficient apparatus for cleansing the bottles. Some members of the trade still fail to realise that they cannot cleanse milk bottles in dirty water—sometimes hot, more often tepid and occasionally cold—and do not give the necessary supervision to the young lads they engage for this purpose. The Inspector on this duty has constantly to remind purveyors that scalding water is very necessary in a milk business and that a plentiful supply is needed if properly cleansed and safe utensils are to be used. Generally speaking, the results of the year's working shew that a higher standard of cleanliness is now being maintained by our milk purveyors. The Milk (Special Designations) Order, 1923. This Order provides for the issue of licences for the production, bottling, and sale of " designated " milks, which may be 69 sold under one of the following descriptions :—Certified, Grade "A," Grade " A " (Tuberculin Tested), Grade " A " Pasteurised and Pasteurised. Forty-six applications for dealers' and supplementary licences were received by the Council during the year and all were granted. As will be seen from the following Table, No. 35, twenty applications were in respect of change in ownership. The total number in force at the end of the year was 26, compared with 26 at the end of 1926. The total amount received in fees was £5 15s. Od. At the request of the Ministry of Health, ten samples of Certified milk were submitted for bacteriological examination. A satisfactory certificate was obtained in each case. TABLE No. 35. Sale of Designated Milks. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. Eltham and Sidcup Farm Dairies, Ltd. Dealer 82, Eltham High Street Certified. Do., do. Do. Do., do. Grade "A." Do., do. Do. 102, Westmount Road Certified. Do., do. Do. Do., do. Grade "A." Edwards & Sons, Ltd., Station Buildings, Forest Hill, S.E. 23. Do. 124, Westmount Road Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Grade "A." Do., do. Do. Do., do. Pasteurised. Do., do. Supplementary. 74, Little Heath, Charlton, S.E. 7. Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do. do. Grade "A" (Pasteurised.) Do., do. Do. Do., do. Grade "A" 70 TABLE No. 35—continued. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. Edwards & Sons, Ltd., Station Buildings, Forest Hill, S.E. 23. Supplementary. 74, Little Heath, Charlton, S.E. 7. Pasteurised. Do., do. Do. 30, Burnt Ash Road, Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Grade "A." Do., do. Do. Do., do. Pasteurised. Do., do. Dealer "Ashurst," Shrewsbury Lane, Plumstead, S.E. Certified. Do., do. Do. Do., do. Grade "A." Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Pasteurised. The Express Dairy Co., Ltd., Tavistock Place, W.C. Dealer 3, Wellington Street, Woolwich. Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). The United Dairies (London), Ltd., 57, Perry Vale, S.E. 23. Do. 124, Westmount Road Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Grade "A" Do., do. Do. Do., do. Pasteurised. Do., do. Do. " Ashurst," Shrewsbury Lane. Certified. Do., do. Do. Do., do. Grade "A." Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A " (Pasteurised). Do., do. Do. Do., do. Pasteurised. 71 TABLE No. 35—continued. Name and Address of Applicant. Nature of Licence. Premises to sell at or from. Designation. The United Dailies (London), Ltd., 57, Perry Vale, S.E. 23. Supplementary. 74, Little Heath, Charlten, S.E. 7. Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Grade "A." Do., do. Do. Do., do. Pasteurised. Do., do. Do. 30, Burnt Ash Road, Lee, S.E. Certified. Do., do. Do. Do., do. Grade "A" (Tuberculin tested). Do., do. Do. Do., do. Grade "A" (Pasteurised). Do., do. Do. Do., do. Grade " A " Do., do. Do. Do., do. Pasteurised. MEAT. The Department has continued to give systematic attention to the meat supply of the Borough, not only at the slaughterhouses, but also in the butchers' shops and stalls. The Public Health (Meat) Regulations, 1924, are proving of great value in improving the conditions under which meat is handled, stored, and sold, and the inspectors find that they can use the regulations as a text book for the progressive education of all concerned in the handling of meat. A marked improvement has taken place compared with previous years, and legal proceedings have been unnecessary. During the year, 2,290 cattle, 11,946 sheep and lambs, 6,579 pigs and 192 calves—a total of 21,007 animals—were killed in the various slaughterhouses in the Borough, and the carcase and internal organs of every one of them were inspected by one of the Council's staff. No single instance of 72 slaughtering without notice was detected. As slaughtering takes place at all hours of the day and on every day of the week, including Sundays, irregular hours of duty have to be worked by the special food inspectors in order to ensure the examination of every carcase. The advantage of detecting unsound meat at the source is obvious, and this part of the regulations is of immense value to the public health. The growth of this side of the Health Department's work will be appreciated when the figures for 1925 and 1920 namely, 13,210 and 17,365, respectively, are brought forward for comparison. The number of whole carcases condemned on account of disease or injuries was 49—1 bullock, 2 sheep and 46 pigs. The number of instances in which partial condemnation was necessary was as follows : 275 cattle, 35 sheep, 284 pigs and 1 calf, making a total of 595. Regular inspection is also made of the shops and stalls where meat is sold, and, where any insanitary conditions exist, the necessary steps are taken to improve them. More attention requires to be given to the transport of meat. Constant pressure is being maintained on all concerned of their obligations under the regulations. Slaughterhouses. In tabular form below is shewn the number of slaughterhouses licensed in 1920, and in January and December, 1927. In addition to visits made for the inspection of carcases, 25 special inspections of these premises (which are licensed by the London County Council) were made. There is no public slaughterhouse in the Borough. TABLE No. 36. 1920. 1926. Jan. Dec. Registered — — — Licensed 9 7 7 OTHER FOOD PREMISES. Bakehouses. The number of bakehouses in the Borough at the end of the year was 41, of which 25 were factories and 9 were underground. The district inspectors made 101 inspections and found it necessary to serve 21 notices. In the main these were associated with want of cleanliness or with carelessness in the conduct of the business. The necessary action was taken by the occupiers without resort to legal proceedings. Fried Fish Shops. There were 67 fried fish shops on the register at the end of the year. These premises were inspected on 180 occasions and 16 notices were served for unsatisfactory conditions. A reasonable standard of cleanliness is now maintained at most of these premises, but in some instances the occupiers require further education in the elementary principles to be followed when preparing food for other people. Ice Cream. The number of premises were ice cream was sold during the year was 136, but in many instances the sale was intermittent. 359 inspections were made, but in only two instances was it necessary to serve formal notices. Other Premises. During the year 232 premises, including restaurants, eating-houses and butchers' shops, were regularly inspected. 1,184 inspections were made and it was necessary to serve 39 notices for unsatisfactory conditions, which were usually due to lack of cleanliness, but occasionally to faults in construction of the premises. In addition, 2,565 visits were paid to shops and to stalls in the markets. UNSOUND FOOD. There were 337 instances of unsound food being surrendered. These compare with 339 in 1926. Included in the 74 food surrendered were 1 ton 6 cwt. 20 lbs. of beef ; 2 tons 10 cwt. 4 lbs. of pork ; 4 cwt. 2 qrs. of pigs' livers ; 1 ton, 1 cwt. 3 qrs. 19 lbs. of ox livers ; and smaller quantities of fish, mutton, veal, rabbits, corned beef, mincemeat, ox lungs, grapes, tomatoes, dates, prunes and almonds. Information was received on two occasions during the year of articles of condemned food coming into the Borough to be used as animal food. The necessary supervision was exercised to ensure that none of this was used for human consumption. Unsound food was seized on three occasions. In one instance the Health Committee considered that a caution would be sufficient, but in the two other instances legal proceedings were instituted. FOOD POISONING. No case of food poisoning was reported during the year. SALE OF FOOD AND DRUGS ACTS. The number of samples taken under these Acts was 572, 26 of which were found by the Public Analyst to be adulterated. The percentage of adulterated samples was 4.5, which compares with 1.8 in the previous year. 13 samples were taken on Sundays, none of which were adulterated. The following Table, No. 37, gives details of the analysis made. 75 TABLE No. 37. Article. Formal samples Informal samples Number analysed Number Adulterated Milk 260 4 264 3 Separated Milk 2 — 2 — Cream 3 3 6 2 Preserved Cream 3 1 4 — Full Cream Unsweetened Condensed Milk – 1 1 – Full Cream Sweetened Condensed Milk – 1 1 – Skimmed Sweetened Condensed Milk – 3 3 – Full Cream Dried Milk — 6 6 — Butter 22 — 22 — Coffee Essence — 2 2 — Coffee and Chicory Essence – 2 2 – Coffee 4 — 4 — Cocoa — 4 4 — Tea — 2 2 — Jam 5 6 11 — Sugar 3 17 20 4 Mustard — 4 4 — Lard 6 — 6 — Brawn — 3 3 — Breakfast Sausage — 6 6 — Sausages 16 42 58 12 Sausage Skins — 1 1 — Sausage Filler — 4 4 — Sausage Seasoning — 1 1 — Mincemeat — 4 4 — Saveloys — 2 2 — Meat Paste — 4 4 — Fish — 6 6 — Shredded Suet — 1 1 1 Shredded Suet with Flour 1 5 6 — 76 TABLE No. 37—continued. Article. Formal samples Informal samples Number analysed Number Adulterated. Dripping 5 — 5 — Pepper — 5 5 — Self-Raising Flour 6 — 6 — Sponge Cakes — 5 5 — Golden Syrup — 1 1 — Baking Powder — 3 3 — Vinegar — 2 2 — Malt Vinegar — 2 2 — Ground Ginger — 2 2 — Raisins — 10 10 — Tinned Tomatoes — 4 4 — Dried Apricots — 3 3 — Candied Peel — 10 10 — Port Wine — 3 3 — Mercury Ointment — 3 3 — Zinc Ointment — 1 1 — Sulphur Ointment — 2 2 — Boric Ointment 1 8 9 1 Sweet Spirits of Nitre 2 8 10 3 Cream of Tartar — 3 3 — Aspirin Tablets 5 5 10 — Tincture of Iodine — 3 3 — Lime Water — 4 4 — Olive Oil — 4 4 — Camphorated Oil — 2 2 — 344 228 572 26 The following figures relating to the fat percentage of each sample of milk examined in the last three years are given below. The minimum legal standard is 3 per cent. of fat. 77 TABLE No. 38. 1925. 1926. 1927. 4.5% and over 1 5 8 4% and under 4.5% 12 9 15 3.5% and under 4% 90 138 106 3% and under 3.5% 109 126 134 Below 3% 2 4 1 214 283 264 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. These regulations provide a standard for condensed milk and lay down the conditions under which it may be described and sold. Five samples were taken during the year and all were found to be genuine. A number of inspections were made of condensed milk exposed for sale in shops in order to ascertain whether labelling was being properly carried out, but no contravention of the regulations was found, probably due in very large measure to the fact that condensed milk is prepared by large manufacturers who take steps to comply with the regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. These regulations provide for the conditions under which dried milk may be sold and labelled. Six samples were taken during the year and submitted to the Public Analyst for analysis. They were reported upon as genuine. There are not many kinds of dried milk on sale, and they are invariably prepared by large manufacturers. 78 THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917. The number of samples of milk submitted for analysis was 264. In addition two samples of separated milk and ten of cream and preserved cream were also examined. The detailed results of the analyses are given below in the form required by the Minister. TABLE No. 39. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917, FOR THE YEAR ENDED 31ST DECEMBER, 1927. 1. Milk and Cream not sold as " Preserved Cream." Number of samples examined for presence of a preservative. Number in which preservative was reported to be present. Percentage and nature of preservative found in each sample. Action taken. Milk 266 (including separated milk.) Nil. — — Cream 6 2 Boric Acid, .38 per cent. Boric Acid, .39 per cent. Informal sample. Explanation accepted. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted to analysis to ascertain if the 79 ments on the label as to preservatives were correct 4 (i) Correct statements made 4 (ii) Incorrect statements made — (iii) Percentage of Preservative Percentage found in each sample : stated on statutory .27 per cent. label : .32 per cent. Not .31 per cent. exceeding .34 per cent. .4 per cent. (6) Determinations made of milk fat in cream sold as Preserved Cream :— (i) Above 35 per cent. 4 (ii) Below 35 per cent. Nil (c) Instances where (apart from analysis) the requirements as to labelling or declaration of Preserved Cream in Article V (2) of the Regulations have not been observed Nil (d) Particulars of each case in which the tions have not been complied with and action taken Nil 3. Thickening substances Nil 4. Other observations (if any) Nil ADULTERATED SAMPLES—ACTION TAKEN. The following Table, No. 40, shews the number of adulterated samples and the action taken in each instance where the samples were formal. 80 TABLE No. 40. Sample No. Article. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 438 Sausages Informal 2.52 grains of boric acid per lb. — 442 Sausages Informal 2.59 grains of boric acid per lb. — 454 Sausages Formal 2.52 grains of boric acid per lb. Vendor cautioned. 459 Sausages Informal 4.2 grains of boric acid per lb. — 474 Sausages Formal 16.1 grains of boric acid per lb. Vendor cautioned. 475 Sausages Formal 2.24 grains of boric acid per lb. Vendor cautioned. 504 Sugar Informal 39 parts per million of sulphur dioxide in excess of legal standard. — 505 Sugar Informal 34 parts per million of sulphur dioxide in excess of legal standard. — 516 Sugar Formal 56 parts per million of sulphur dioxide in excess of legal standard. Vendor cautioned. 518 Sugar Informal 28 parts per million of sulphur dioxide in excess of legal standard. — 557 Shredded Wheat. Informal 32 per cent. of rice flour. 10 Sausages Informal 3.71 per cent. of boric acid per lb. — 21 Sausages Informal 1.61 per cent. of boric acid per lb. — 153 Cream Informal .38 per cent. boric acid. — 81 TABLE No. 40—continued. Sample No. Artilce. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 226 Milk Formal 15.66 per cent. deficient in fat. Fined 20/- and 21/- costs. 159 Cream Formal .39 per cent. of boric acid Explanation accepted. 214 Boric Ointment- Informal 30 per cent. deficient in boric acid. 356 Milk Formal 7.3 per cent. of added water. Vendor cautioned. 398 Milk Informal 2.6 per cent. of added water. — 286 Sausages Informal 8.05 grains of boric acid per lb. — 302 Sausages Formal 1.54 grains of boric acid per lb. Vendor cautioned. 352 Sausages Informal 153 parts per million of sulphur dioxide. — 368 Sausages Formal 98.5 parts per million of sulphur dioxide. Vendor cautioned. 306 Sweet Spirits of Nitre. Informal 95.7 per cent. deficient in ethyl nitrite. — 307 Sweet Spirits of Nitre. Informal 32.1 per cent. deficient in ethyl nitrite. — 313 Sweet Spirits of Nitre. Formal 96.1 per cent. deficient in ethyl nitrite. Summons dismissed. OTHER LEGAL PROCEEDINGS. In Table No. 41, which follows, are set out the particulars of the various prosecutions instituted in respect of food other than under the Sale of Food and Drugs Acts. F 82 TABLE No. 41. Date of Hearing. Offence. Result. 10th June Exposure for sale of 6-lbs. of grapes unsound and unfit for food. Fined £1, Costs £1 1s. 0d. Deposit for sale 12-lbs. of grapes unsound and unfit for food. Summons withdrawn. 7th July Deposit for sale of minced meat unfit for the food of man. Case dismissed. 83 SECTION VI.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown :— TABLE No. 42. Number of new houses erected during the year :— (a) Total 1,058 (6) With State assistance under the Housing Acts, 1919, or 1923 (i) By the Local Authority 783 (ii) By other bodies or persons 119 1. Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,153 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Consolidated Regulations, 1925 2,672 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,214 84 2. Remedy of Defects without Service of Formal Notices * Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,642 * Includes intimation notices. 3. Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repairs (2) Number of dwelling houses which were rendered fit :— (а) By Owners — (b) By Local Authority in default of Owners — (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close (b) Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 709 (2) Number of dwelling houses in which defects were remedied :— (a) By Owners 648 (b) By Local Authority in default of owners — 85 (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (1) Number of representations made with a view to the making of closing orders 4 (2) Number of dwelling houses in respect of which closing orders were made *3 (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit (4) Number of dwelling houses in respect of which demolition orders were made (5) Number of dwelling houses demolished in pursuance of demolition orders — * Includes one underground room. The number of structurally separate occupied dwellings in the borough at the time of the Census was 26,048. The number now is estimated to be 28,707, and of these 24,150 are occupied by members of the working classes. The number of houses erected in 1927 was 1,058, 783 being erected by the Borough Council and 275 by private enterprise; 119 of these with State assistance. In 1926 the corresponding figures were 373, 170 and 203. The year just ended is the first year in which the figures for the number of houses erected exceeded the pre-war average, and is almost entirely due to the greatly accelerated rate at which houses have been erected under the Council's scheme during the last six months of the year. The general state of housing in the borough was fully reported on in the Annual Report for 1925 and the conditions outlined therein have not been substantially altered. Overcrowding is still observed, but owing to the increased 86 rate of house production we have been able to deal with many of the cases through the Council's scheme. It is not possible always to adopt this remedy, because overcrowding in many instances is often associated with large families of limited means, and people living under these conditions have often to come to a decision as to whether it is better to spend money on a larger rent for a larger house, or to continue to live under overcrowded conditions and spend the money on food. Both have points in their favour and different individuals decide in different ways. Another aspect of the housing problem is the fact that in this borough nearly 4,000 houses which were originally intended for one family are now occupied by two or more without being specially adapted for the purpose. This arrangement very often starts with shelter being given temporarily to newly married couples with limited means, but the arrival of a young family soon causes difficulties and leads to an uncomfortable standard of living on the part of each family. The sub-tenant usually finds difficulty in getting other rooms because of his young family, and the tenant often finds the presence of the sub-tenant inconvenient and irksome, if not actually disagreeable. A condition of overcrowding may follow on this, but, whether it does or not, such method of living is far from ideal and is an aspect of the housing question that sooner or later must receive the consideration of the Council. It must not be imagined, however, that people live in these circumstances because of economic conditions; in many cases they are paying rent not far short of what they would pay for a decent selfcontained dwelling. The hutments continue to be used as permanent homes, but as time progresses these require more and more attention to maintain them in a habitable condition. They were erected as a war-time measure and have outlived this purpose. 87 The London County Council allocate a very small proportion of houses under their building scheme to Woolwich residents. Houses Let in Lodgings. During 1926 the new bye-laws for houses let in lodgings received the approval of the Minister of Health and now apply to the whole of London. The definition of a house let in lodgings is as follows :— " A house or part of a house intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family, but shall not include a house in which the tenant resides on the premises and in which not more than two persons in addition to the tenant and his family also reside at any one time," but the Minister of Health only allowed the bye-laws except in so far as they apply to any lodging-house in which the tenant resides and not more than one family is lodged. So far as the Borough is concerned, houses in Eltham are now subject to these bye-laws, whereas previously they were exempt because no bye-laws had been made by this Council controlling them. Under these new bye-laws registration is abolished. Action taken under the Housing Act, 1925. Under this Act the Council have power to secure the closing of underground rooms illegally occupied as sleeping places ; to make closing and demolition orders, and to serve notices on the owners calling on them to render houses fit for human habitation, and, in default, have power to do the work themselves and recover the cost from the owners. During the year under review, four representations were made, three with 88 respect to dwelling houses and one with respect to an underground room. Closing orders were made in all cases. The details are set out in the following Table. TABLE No. 43. Action taken under Housing Acts. Date of Representation. Premises. Date of Closing Order. Remarks. 6th April 91, Plumstead High Street. 4th May — 12th October 30, Frederick Place. 2nd November — 8th November 28, Burrage Road 30th November Underground Room as a sleeping place. 7 th December 134, Plumstead High Street. — Closing Order made in 1928. A closing Order made in 1926 in respect of premises at 69, New Road, was determined in 1927, as the premises were converted into a lock-up shop. Underground Sleeping Rooms. One underground room was represented during the year and a closing order was made by the Council. Tents and Vans. The number of tents and vans in Woolwich is almost negligible and bye-laws regulating the use of these were made by the Council in 1903. All tents and vans were regularly inspected during the year and steps were taken to ensure that the bye-laws were observed. It was necessary to serve notices for three offences. 89 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. During the year one application was made by the occupier of a house for a certificate that the house occupied by him was not in a reasonable state of repair. The application was not granted. New Houses. Water certificates were granted during the year for the following new houses erected in the Borough : Council's Housing Scheme. Eltham 13 12th January 43 9th March 40 6th April 117 11th May 57 15th June 68 8th July 335 14th September 43 12 th October 13 8th November 54 .. 7th December. Private Enterprise. Plumstead, West— Shrewsbury Lane, " Timberham " 12th January Cleanthus Road, " The Haven " do. Shooters Hill, " Wayside " 9th February Griffin Road, St. Paul's Vicarage 6th April The Slade, 23 do. Cleanthus Road, 23 11th May The Slade, 22 15th June Shooters Hill, " Belsaye " 8th July Pegwell Street, 1 do. Shooters Hill, " Rosebank " 27th July Pegwell Street, 3, 5, 7 do. Red Lion Lane— " Gaika," " Castle Lodge " 14th September Pegwell Street, 9, 11 do. 90 Pegwell Street, 2, 4, 6, 8 12th October Red Lion Lane, " Evercreech " do. Red Lion Lane, " The Bungalow " 8th November Red Lion Lane, " Hillside " 7th December Plumstead, East— Openshaw Road, 16 12th January Brodrick Grove, 2-14 (even) 9th March 1-13 (odd) Verdun Road, 7 do. King's Highway, 7, 8 do. Openshaw Road, 18-36 (even) 6th April Openshaw Road, 17-33 (odd) 11th May Brodrick Grove, 16-34 (even) 15th June Brodrick Grove, 15-29 (odd) 8th July Blithdale Road, 121-147 (odd) 27th July Brodrick Grove, 31-45 (odd) do. Blithdale Road, 149-181 (odd) 14th September Blithdale Road, 185-191 (odd) do. Bostall Hill, 56 do. Blithdale Road, 193-215 (odd) 12th October Eltham.— Southwood Road, 85, 87 12th January Footscray Road, 166, 168 do. Green Lane, Croft Villas, 21, 22, 23, 24 do. Glenlea Road, 8, 10 do. Dobell Road, 44, 46 do. Gerda Road, 69, 71, 73, 75 9th February Avery Hill Road, " Cawsang," " hurst," " Sunnyside," " Medhurst " do. Bexley Road, " Sandy Ridge " do. Weigall Road, 13, 14 do. Dobell Road, 48 9th March Glenlea Road, 12 do. Footscray Road, 85, 87 do. 91 Well Hall Road, 82, 84, 130 6th April Glenlea Road 14 do. Footscray Road, " Petersville," " Orchard Leigh" do. Green Lane, Croft Villas, 25, 26 do. Glenesk Road, 42, " Sarona " do. Dunvegan Road, 97 do. Southwood Road, 142, 144 do. Footscray Road, " Pattiswicke " 11th May Bexley Road, " The Haven " do. Gerda Road, 70 do. Footscray Road, 77, 79 do. Glenesk Road, 48, 38, 40, 44, 46 15th June Footscray Road, 162, 164, 420, 422 do. Footscray Road, 81, 83, Sports Pavilion do. Westmount Road, 129 do. Bexley Road, " Brightsholme " do. Westmount Road, 125, 127 8th July Well Hall Road, 74, 76, 78, 80 do. Weigall Road, 28 do. Glenlea Road, 16, 24 do. Footscray Road, " Croscombe," " The Villa," 235, 237, 239 do. Glenlea Road, 20, 22 27th July Green Lane, " Gwendene " do. Well Hall Road, " The Welcome Inn " do. Footscray Road, 139 do. Southwood Road, 134, 136, 138, 140 do. Green Lane, " Carisbrooke " 14th September Cadwallon Road, 20, 22, 26 do. Glenlea Road, 18 do. Glenesk Road, " Chedzoy " do. Green Lane, " St. Christophe," 32 do. Bexley Road, " Badlesmere " do. Footscray Road, 231, 233,. 235 do. Weigall Road, 27 do. 92 Westmount Road, 123 do. Gerda Road, 72, 74, 76 12th October Weigall Road, 25, 26 do. Southwood Road, 95 do. Glenesk Road, 52 do. Cadwallon Road, 3 do. Dunvegan Gardens, 67, 69, 75, 77 do. Bexley Road, " Stranraer " do. Footscray Road, 227, 229 do. Green Lane, " Tsenruo " do. Archery Road, 31, 32, 33, 34 do. Footscray Road, 137 do. Footscray Road, 221, 424, 426 8th November Green Lane, 34 do. Glenlea Road, " Woodside " do. Cadwallon Road, 1,5 do. Dunvegan Gardens, 73 7th December Green Lane, 30, 36, " Clontarf," " Westfield" do. Footscray Road, 135, 223 do. Southwood Road, 109-119 (odd) do. Cadwallon Road, 24, 28 do. Woolwich— Rectory Place, " Queen Victoria " P.H. 14th September 93 SECTION VII.—PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. NOTIFICATION. The total number of notifications, excluding duplicates, was 1,585, compared with 1,578 in 1926 and 1,375 in 1925. In addition, 457 cases of Measles, including German Measles, came to the knowledge of the department, mainly through the school medical service. Detailed statistics relating to the incidence of infectious disease, each year since 1901, will be found in Table No. 48. The following diseases are notifiable in the Borough :— Anthrax Pneumonia, Acute Primary Cerebro-spinal Meningitis Pneumonia, Acute Cholera Influenzal Continued Fever Poliomyelitis Diphtheria Plague Dysentery Puerperal Fever Encephalitis Lethargica Puerperal Pyrexia Erysipelas Relapsing Fever Enteric (or Typhoid) Fever Scarlet Fever Glanders Small Pox Hydrophobia Trench Fever Malaria Tuberculosis Membranous Croup Typhus Fever Ophthalmia Neonatorum Zymotic Enteritis The following four Tables are published in accordance with the requirements of the Ministry of Health, and show the total number of cases of infectious disease notified during the year, the number of cases admitted to hospital or sanatorium, the total number of deaths occurring from these diseases, and the distribution and case rate per 1,000 of the population of the various registration districts in the Borough. 94 TABLE No. 44. INFECTIOUS DISEASES. Diseases. Total cases notified. Admissions to Hospital or Sanatorium. Total Deaths. Diphtheria 278 273 10 Scarlet Fever 478 451 — Enteric Fever (including Para-typhoid) 9 9 — Puerperal Fever 8 6 3 Puerperal Pyrexia 30 21 — Erysipelas 65 30 3 Pneumonia 316 129 94 Malaria 3 2 1 Ophthalmia Neonatorum 19 7 — Dysentery 1 1 1 Encephalitis Lethargica 6 6 3 Cerebro-Spinal Meningitis 4 4 — Poliomyelitis 3 2 — Zymotic Enteritis 12 8 6 Tuberculosis Pulmonary Males 143 153 87 Females 126 105 61 Total 269 258 148 Tuberculosis Non-Pulmonary Males 41 15 16 Females 43 20 14 Total 84 35 30 Measles 457 4 1 2042 1246 300 95 TABLE No. 45. CASES OF INFECTIOUS DISEASES NOTIFIED, 1927. Diseases. Number of Cases Notified. Age Groups. All Ages. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years. 65 and over. Diphtheria 278 4 9 13 17 38 110 30 30 20 2 5 .. Scarlet Fever 478 3 10 29 33 46 216 59 36 38 7 1 .. Enteric Fever 9 .. .. .. .. 1 .. .. 2 2 .. 4 .. Puerperal Fever 8 .. .. .. .. .. .. .. .. 7 1 .. .. Puerperal Pyrexia 30 .. .. .. .. .. .. .. .. 21 8 1 .. Erysipelas 65 1 1 3 1 1 .. 2 3 9 11 26 7 Pneumonia 316 14 14 13 21 17 40 12 17 44 33 57 34 Malaria 3 .. .. .. .. .. .. .. .. 1 .. 2 .. Ophthalmia Neonatorum 19 19 .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. 1 .. .. .. Encephalitis Lethargica 6 .. .. .. .. .. 1 .. 1 1 1 2 .. Cerebro-Spinal Meningitis 4 2 1 .. .. .. .. .. .. 1 .. .. .. Poliomyelitis 3 .. .. 1 .. .. 1 .. 1 .. .. .. .. Zymotic Enteritis 12 4 6 .. 1 1 .. .. .. .. .. .. .. Tuberculosis Pulmonary Males 143 .. .. .. .. .. 4 2 16 62 23 31 5 Females 126 .. 1 1 2 .. 5 1 32 51 20 13 .. Total 269 .. 1 1 2 .. 9 3 48 113 43 44 5 Tuberculosis Non-Pulmonary Males 41 . . 1 5 1 1 8 7 3 8 4 3 Females 43 2 3 .. .. 2 9 7 3 13 .. 2 2 Total 84 2 4 5 1 3 17 14 6 21 4 5 2 Measles (including German Measles). 457 3 2 5 13 37 336 57 4 .. .. .. .. 2042 52 48 70 89 144 730 177 148 279 110 147 48 96 TABLE No. 46. Cases of Infectious Diseases Notified in the Borough and Parishes during the year 1927, shewing the Case Rate per 1,000 population. Diseases. X Ml s 0 E o n Total Cases Notified in each locality. Case Rates per 1,000 Population. js 0 1 "o o £ Plumstead. a 9 J a J3 be 3 o E O « X o & 8 £ Plumstead. e I J a . 00 £ 3 H ■ o £ 3 H Diphtheria 278 121 76 49 32 1-97 3-89 1-92 1-39 0-91 Scarlet Fever 478 162 133 88 95 3-40 5-21 3-36 2-50 2-73 Enteric Fever 9 4 2 2 1 0-06 013 0-05 0-06 0-03 Puerperal Fever 8 3 1 . . 4 0-06 0-10 0-03 0-12 Puerperal Pyrexia 30 6 4 9 11 0-21 019 0-10 0-26 0-32 Erysipelas 65 14 15 19 17 0-46 0-45 0-38 0-54 0-49 Pneumonia 316 83 72 76 85 2-24 2-67 1-82 2-16 2-44 Malaria 3 1 2 002 003 0-06 Ophthalmia Neonatorum 19 9 3 4 3 013 0-29 0-08 0-11 0-09 Dysentery 1 1 0-01 0-03 Encephalitis Lethargica 6 3 2 i 004 010 0-05 0-03 Cerebro-Spinal Meningitis 4 2 1 l 003 0-06 0-03 0-03 Poliomyelitis 3 3 0-02 0-09 Zymotic Enteritis 12 2 8 2 009 0 06 0-23 0-06 Pulmonary Tuberculosis 269 83 73 66 47 1-91 2-67 1-84 1-87 1-35 Tuberculosis (Non-pulmonary) 84 30 18 17 19 0-60 0-96 0-45 0-48 0-55 Measles (including German Measles). . 457 42 153 65 197 3-25 1-35 3-86 1-84 5-66 2042 566 553 405 518 14-51 18-20 13-95 11-20 14-90 97 TABLE No. 47. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES (INCLUDING MEASLES), 1927. Diseases. Number of Deaths. All Ages. Age Groups. Under 1 1- 2- 3- 4- 5-10 10-15 15-20 20-35 35-45 45-65 65- Diphtheria 10 .. 1 1 1 1 5 .. .. .. .. 1 .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. .. .. .. .. .. 3 .. .. .. Puerperal Pyrexia . . .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 3 .. .. .. .. .. .. .. .. 1 1 1 .. Pneumonia 94 8 7 4 3 3 2 .. 5 3 11 20 28 Malaria 1 .. .. .. .. .. .. .. .. .. .. 1 .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. .. .. 1 .. Encephalitis Lethargica 3 .. .. .. .. .. .. .. .. .. 2 .. 1 Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. Poliomylitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 6 5 .. 1 .. .. .. .. .. .. .. .. .. Tuberculosis Pulmonary Males 87 .. .. .. .. .. .. .. 8 25 16 30 8 Females 61 .. .. 1 .. .. .. 3 11 28 5 11 2 Total 148 .. .. 1 .. .. .. 3 19 53 21 41 10 Tuberculosis Non-Pulmonary Males 16 .. .. 1 .. 1 4 1 1 3 3 1 1 Females 14 1 4 .. .. 1 2 1 1 2 2 .. .. Total 30 1 4 1 .. 2 6 2 2 5 5 1 1 Measles (including German Measles). 1 .. .. 1 .. .. .. .. .. .. .. .. .. 300 14 12 9 4 6 13 5 26 65 40 66 40 98 TABLE No. 48. Notification of Infectious Diseases, 1901 to 1927. Year. Small-pox. Diphtheria and Mem. Croup Scarlet Fever. Enteric Fever. Erysipelas. Puerperal Fever, ,, Pyrexia × Tuberculosis. Continued Fever. Cerebro Spinal Fever. Anterior Poliomyelitis. Encephalitis lethargica. Ophthalmia Neonatorum. Zymotic Enteritis.§ Anthrax. Malaria. Dysentery. Pneumonia.† Measles.‡ 1901 21 216 311 68 72 8 .. 1 .. .. .. .. .. .. .. .. .. 323 1902 228 233 267 50 98 11 189 1 .. .. .. .. .. .. .. .. .. 646 1903 6 186 389 42 58 2 165 3 .. .. .. .. .. .. .. .. .. 661 1904 6 163 472 25 74 5 186 1 .. .. .. .. .. .. .. .. .. 1240 1905 7 273 513 27 83 12 145 1 .. .. .. .. 212 .. .. .. .. 465 1906 .. 387 528 40 97 8 176 .. .. .. .. .. 366 .. .. .. .. 825 1907 .. 275 1023 27 110 6 150 .. 1 .. .. .. 93 .. .. .. .. 1453 1908 .. 362 596 19 90 6 154 .. 1 .. .. .. 173 .. .. .. .. 519 1909 .. 268 1027 13 113 9 206 .. .. .. .. .. 149 .. .. .. .. 768 1910 1 171 524 10 89 7 196 .. 1 .. .. .. 102 .. .. .. .. 396 1911 .. 239 518 16 82 16 375 .. 1 3 .. 8 866 .. .. .. .. 801 1912 3 429 474 20 87 2 689 .. 1 3 .. 20 129 .. .. .. .. 775 1913 .. 321 626 14 70 8 675 .. .. 1 .. 14 338 .. .. .. .. 387 1914 .. 416 714 18 107 7 498 .. 1 .. .. 18 199 .. .. .. .. 967 1915 .. 286 601 31 138 6 489 .. 50 2 .. 19 173 .. .. .. .. 1179 1916 .. 271 232 9 95 16 469 .. 17 .. .. 33 80 .. .. .. .. 1590 1917 .. 277 147 12 79 12 543 .. 22 1 .. 41 101 .. .. .. .. 1710 1918 .. 240 222 12 61 14 660 .. 11 3 .. 23 118 .. .. .. .. 800 1919 4 398 243 26 63 7 474 .. 7 1 3 34 123 1 61 7 123 1886 1920 1 427 538 6 82 13 428 .. 6 .. 3 29 31 .. 29 1 136 1013 1921 .. 592 1351 11 59 14 356 .. 2 .. 9 32 454 .. 10 4 236 481 1922 .. 437 511 8 37 11 305 1 2 4 3 26 31 .. 11 .. 345 2698 1923 .. 152 334 16 40 8 311 .. 5 6 1 18 49 .. 4 1 242 194 1924 .. 195 440 11 45 7 342 .. 12 5 17 27 13 .. 3 1 354 2679 1925 .. 299 364 16 44 9 300 .. 5 1 10 31 13 .. 5 1 277 1916 1926 .. 393 411 8 .. 11 349 1 9 5 7 18 23 .. 5 .. 292 1246 1927 .. 278 478 9 65 38 353 .. 4 3 6 19 12 .. 3 1 316 457 * Voluntary Notification to 1910 ; partial to 1912 : all cases thereafter. † Includes all forms of Pneumonia. ‡ Measles compulsorily notifiable from 1/1/1916 to 31/12/1919. § Compulsory notification of Zymotic Enteritis commenced 1913. × Compulsory notification of Puerperal Pyrexia commenced October, 1926. 99 SMALL POX. No case of small pox was notified during the year, and no action was necessary by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1919. SCARLET FEVER. Notification. During the year 478 cases of scarlet fever were notified, compared with 411 in 1926 and 364 in 1925. The case rates for the various registration districts in the Borough are given in detail in Table No. 46. The number of notifications received each quarter was as follows:— First quarter 83 Third quarter 109 Second quarter 144 Fourth quarter 142 Deaths. There were no deaths from scarlet fever during 1927. Multiple Cases. The following Table shows the house distribution by wards. The term "house" is synonymous with the term "family," except in seven instances, where two families were involved. TABLE No. 49. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Eltham. Total Houses. Total Cases. Number of houses in which 1 caase occurred 24 11 23 68 20 22 16 38 12 44 60 338 338 2 cases occurred 1 1 4 7 3 2 2 5 3 10 7 45 90 3 ,, ,, 1 — 1 — 1 — 1 1 1 1 7 14 42 4 ,, ,, — — — 1 — — — 1 — — — 2 8 Total Houses 26 12 28 76 24 24 19 45 16 55 74 399 478 100 Return Cases. The following Table shows the number of return cases, the dates of admission to hospital, the dates of discharge from hospital, and some observations on the condition of the primary case on discharge. TABLE No. 50. No. in register. Date admitted to hospital. Date discharged. Total days in hospital. Onset of secondary case. Remarks on primary case. 1926. 343 30/10/26 2/2/27 95 16/2/27 — 376 27/11/26 8/1/27 42 13/1/27 16/1/27 — 25/1/27 1927. 69 20/3/27 3/5/27 44 14/5/27 179 3/6/27 20/7/27 47 26/7/27 — 152 17/5/27 6/7/27 50 4/8/27 — 153 16/5/27 6/7/27 51 279 6/8/27 21/9/27 46 3/10/27 52 1/3/27 13/5/27 73 30/5/27 313 8/9/27 19/10/27 41 3/11/27 Nasal discharge 12 22/1/27 26/3/27 63 12/4/27 Peeling. 321 13/9/27 5/10/27 22 10/10/27 — 230 3/7/27 29/10/27 118 17/11/27 Ear discharge 27/11/27 62 13/3/27 7/5/27 55 24/5/27 76 27/3/27 6/5/27 40 188 12/6/27 6/8/27 55 17/8/27 — 289 21/8/27 15/10/27 55 21/10/27 Home Isolation. Twenty-seven cases, or 5.7 per cent. were isolated at home, and in no instance did a return case occur. When cases are isolated at home, frequent inspections, at irregular intervals, are made by the District Sanitary Inspectors, in order to ensure that proper precautions for preventing the spread of the disease are being taken. 101 Employees of the Royal Arsenal are not allowed to remain at work unless cases are removed to hospital or a certificate of efficient home isolation is issued by the Medical Officer of Health. During the year one such certificate was issued. Dick Test. This has not been employed in the area so far as I am aware. DIPHTHERIA. Notification. During the year 278 cases of diphtheria were notified, compared with 393 in 1926 and 299 in 1925. The case rates for the various registration districts in the Borough are given in detail in Table No. 46. The number of notifications received each quarter was as follows:— First quarter 84 Third quarter 50 Second quarter 56 Fourth quarter 88 Deaths. There were ten deaths, five occurring in school children, four in those under school age, and one in an adult. Return Cases. There were two return cases amongst those isolated in hospital. Multiple Cases. The following Table shows the house distribution by wards. The term "house" is synonymous with the term "family," except in nine instances where two families were involved. 102 TABLE No. 51. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas'. Eltham. Total Houses. Total Cases. Number of Houses in which 1 case occurred 23 16 25 34 16 11 19 17 8 34 23 226 226 2 cases occurred — 1 5 3 1 1 2 1 1 1 3 19 38 3 ,, ,, — — — — 1 — — — — 1 1 3 9 4 ,, ,, — — — — — — — — — — — — — 5 „ ,, — — — 1 — — — — — — — 1 5 Total Houses 23 17 30 38 18 12 21 18 9 36 27 249 278 Antitoxin. Diphtheria antitoxin is kept at the Town Hall, the Plumstead Library, and the Eltham Library, and is supplied to medical practitioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 36,000 units. The total cost to the Council was £2 14s. 0d., all of which was recovered. The corresponding figures in 1926 were as follows:—56,000 units, total cost, £4 4s. Od.; none issued free. Schick Test. This has not been employed in the area so far as I am aware, and no artificial measures of immunisation against the disease have been made use of. Home Isolation. Five cases were isolated at home. The same routine was carried out as in the case of scarlet fever. ENTERIC FEVER. Nine cases were notified during the year. No deaths were certified as due to this disease. 103 In the following Table details of each case are given:— TABLE No. 52. No. Date. Sex. Age. Diagnosis. Final Diagnosis. 1927. 1 Mar. 8 M. 55 Enteric Fever Paratyphoid B. 2 June 14 F. 47 Enteric Fever Cerebellar abscess. 3 July 28 F. 28 Enteric Fever Paratyphoid B. 4 Aug. 22 F. 4 Typhoid Fever Typhoid Fever. 5 Aug. 31 M. 16 Paratyphoid Fever Paratyphoid B. 6 Sept. 22 M. 22 Enteric Fever Enteric Fever. 7 Oct, 13 F. 51 Paratyphoid B. Paratyphoid B. 8 Oct. 17 M. 63 Enteric Fever Meningitis. 9 Nov. 30 F. 19 Enteric Fever Typhoid Fever. ENCEPHALITIS LETHARGICA. Six cases were notified during the year, and all were admitted to hospital. In 1926 there were seven cases. In tabular form is given below the ultimate diagnosis of each case and the result where known. TABLE No. 53. Date notified. Sex. Age. Ultimate Diagnosis. Remarks. 1927. Mar. 5 M. 57 Encephalitis Lethargica Died 15/3/27. Mar. 16 M. 15 Encephalitis Lethargica — May 27 M. 23 Encephalitis Lethargica Military Case. June 8 M. 41 Encephalitis Lethargica Died 23/6/27. Oct. 17 F. 5 Encephalitis Lethargica Military Case. Oct. 17 M. 63 Meningitis Died 19/10/27. 104 CEREBROSPINAL MENINGITIS. Four cases were notified during the year, details of which, and the ultimate diagnosis, are set out in the following Table. All the cases were admitted to hospital. TABLE No. 54. Date notified. Sex. Age. Ultimate Diagnosis. Remarks. 1927. May 20 F. 1¼ Tuberculous Meningitis Died 31/5/27. July 11 F. 23 Tuberculous Meningitis — Aug. 30 M. ¾ Cerebrospinal Meningitis — Nov. 24 M. 1 Zymotic Enteritis — PNEUMONIA. During the year 280 notifications of acute primary pneumonia and 36 of acute influenzal pneumonia were received. Ninety-four deaths were certified as due to acute lobar pneumonia or to acute broncho-pneumonia. Twentytwo persons died from acute influenzal pneumonia. The Council have a scheme whereby nursing assistance is provided for persons suffering from pneumonia and requiring such assistance. During the year 61 cases were nursed at home, 956 visits being made by the nurses of the local nursing associations. The total cost of this service to the Council was £59 15s. Od. In tabular form is given below the notification of, and deaths from, the pneumonias each year since 1923. 105 TABLE No. 55. Year. Notifications. Deaths. 1923 242 65 1924 354 95 1925 277 97 1926 292 81 1927 316 94 The next Table shows the distribution of pneumonia in each Ward of the Borough, classified according to the type of pneumonia given on the notification certificate:— TABLE No. 56. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary Total. Dockyard 3 2 16 21 St. Mary's 1 2 I 4 8 River 4 10 6 8 28 St. George's 9 8 4 5 26 Burrage 2 1 2 5 10 Herbert 5 2 4 1 12 Glyndon 9 9 2 9 29 St. Margaret's 9 4 4 4 21 Central 5 3 2 7 17 St. Nicholas 18 12 4 25 59 Eltham 19 13 7 46 85 84 66 36 130 316 The following Table, No. 57, shows the number of notifications of pneumonia received each month, classified by sex and according to type incidence. It also shows the number of deaths occurring from acute pneumonia and from influenzal pneumonia. 106 TABLE No. 57. Month. Male. Female. Total. Type. No. of Deaths Lobar. Broncho. Influen zal. Acute Primary (not specified). Acute Primary Pneumonia Influenzal Pneumonia January 36 36 72 8 22 12 30 26 7 February 31 9 40 4 10 10 16 13 11 March 12 10 22 7 4 3 8 9 — April 13 11 24 7 6 3 8 8 — May 27 10 37 16 4 2 15 5 1 June 19 3 22 8 3 1 10 4 — July 11 4 15 5 3 — 7 3 — August 4 3 7 5 1 — 1 3 — September 5 1 6 2 — — 4 6 — October 13 9 22 8 4 — 10 4 — November 7 1 8 3 2 — 3 3 — December 26 15 41 11 7 5 18 10 3 204 112 316 84 66 36 130 94 22 ERYSIPELAS. The number of notifications received during the year was 65, compared with 46 in 1926. No special comment is called for on the incidence of this disease. MALARIA, TRENCH FEVER AND DYSENTERY. Three cases of malaria were notified, and one of dysentery. No cases of trench fever were notified during the year. The incidence of malaria and dysentery calls for no comment. PUERPERAL FEVER AND PUERPERAL PYREXIA. Eight cases of puerperal fever and thirty cases of puerperal pyrexia were notified during the year, compared with four and seven, respectively, in 1926. Most of the cases of puerperal pyrexia were febrile conditions coinciding with the 107 puerperium and were not puerperal infection, but some of them should have been notified as puerperal fever. The number of cases treated in hospital was 27, viz., 6 in hospitals of the Metropolitan Asylums Board, 7 in Maternity Hospitals, 10 in Poor Law Institutions, 3 in Cottage Hospitals, and one in a general hospital. The number of deaths was three. The Council's scheme for the administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, is referred to in detail in the Maternity and Child Welfare Section. OPHTHALMIA NEONATORUM. During the year 19 cases of Ophthalmia Neonatorum were notified, and 7 cases were treated in hospital. In tabular form is shown below, as required by the Ministry of Health, the result of each case. TABLE No. 58. Ophthalmia Neonatorum. Date Notified. Cases Treated. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. Jan. 7 Yes Yes — — — ,, 19 Yes — Yes — — — ,, 19 Yes — Yes — — — ,, 26 Yes — Yes — — — ,, 29 — Yes Yes — — — Feb. 16 Yes — Yes — — — March 9 Yes — Yes — — — April 3 — Yes Yes — — — 13 — Yes Yes — — — May 28 Yes — Yes — — — June 24 — Yes Yes — — — July 9 Yes — Yes — — — 14 Yes — Yes — — — ,, 20 — Yes Yes — — — ,, 21 Yes — Yes — — — Aug. 6 Yes — Yes — — — Sept. 18 Yes — Yes — — — Dec. 6 — Yes Yes — — — ,, 8 — Yes Yes — — — 108 Nursing. During 1927, eight cases were nursed at home at a total cost to the Council of £7 7s. The number of visits paid by the nurses was 147, thus averaging 18 visits per case. ZYMOTIC ENTERITIS. Twelve cases of Zymotic Enteritis were notified, compared with 23 in 1926. The number of cases notified and the number of deaths certified to be due to diarrhoeal diseases in each quarter are shown below. Five deaths were in infants under one year of age. Quarter. Cases. Deaths. First 7 2 Second 1 1 Third 3 1 Fourth 1 2 WHOOPING COUGH. During the year 264 cases of Whooping Cough came to the knowledge of the Department from the School Medical Service. As this disease is not notifiable in Woolwich, knowledge can only be obtained by the Department from this service, or incidentally, by casual discovery by the health visitors during their daily routine. Deaths. The number of deaths was 10, compared with 3 in 1926 and 17 in 1925. All the deaths occurred in children under five years of age. MEASLES. Measles is not a notifiable disease in Woolwich, and» consequently, we depend on the notifications received from the School Medical Service and cases discovered by the health visitors as an index of its prevalence—an index which must be considerably below the number. By these methods 109 we obtained knowledge during the year of 457 cases, of which 240 were German Measles ; 60 of these were children under 5 years of age. The number of cases discovered by health visitors was 31. Deaths. There was only one death from measles during the year, which occurred in a child under 5 years of age. Home Nursing. During the year no cases were nursed at home under the Council's scheme. Removal to Hospital. Children suffering from measles are admitted to the hospitals of the Metropolitan Asylums Board on the certificate of the Medical Officer of Health. During the year four cases were admitted, compared with 17 in the previous year. ANTERIOR POLIOMYELITIS. Three notifications were received during the year, compared with five in 1926 and one in 1925. Home Nursing. Under the Council's Maternity and Child Welfare scheme, home nursing assistance for children under five can be provided, and orthopaedic treatment given at the Remedial Clinic, Thomas Street, Woolwich. All cases notified are kept under observation until the children become of school age. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The procedure in regard to these matters was fully described in the Annual Report for 1925, and as no change has taken place during the year, it is not considered necessary to repeat this matter this year. 110 Disinfection. The Disinfection Station is sometimes used for special disinfection at the request of inhabitants. A small charge is made in these cases, and during the year 65 such disinfections were carried out, and fees amounting to £29 6s. 6d. were paid. In tabular form below is shown the amount of disinfection which was carried out during the year. TABLE No. 59. Rooms disinfected after infectious diseases 657 ,, ,, „ tuberculosis 307 ,, ,, ,, verminous cases 43 Rooms disinfected for other reasons 38 Total articles disinfected 22,058 Disinfestation. As in previous years children have been sent to the Cleansing Station for disinfestation under the arrangement made with the London County Council. The following Table, No. 60, shows the extent to which this station has been used during the last five years. TABLE No. 60. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 1923 280 1731 2011 18 1 19 2030 1924 337 1924 2261 17 10 27 2288 1925 359 2082 2441 23 6 29 2470 1926 427 1934 2361 24 2 26 2387 1927 379 1852 2231 34 20 54 2285 1ll TUBERCULOSIS. This section of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1912, and under the Dispensary Scheme as approved by the Ministry of Health and the London County Council, who contribute 50 per cent. and 25 per cent. respectively of the net expenditure of the scheme. Staff. The staff of the Dispensary consists of one wholetime Tuberculosis Officer, one half-time Assistant Medical Officer, three Tuberculosis Visitors, one Clerk Dispenser, and one Lay Organiser, who also acts as Secretary of the Care Committee. Post-Graduate Course. In December one of the Tuberculosis Visitors attended the seventh Winter School organised by the Women Sanitary Inspectors' and Health Visitors' Association. The course extended over two weeks. This is the second occasion on which a Tuberculosis Nurse has attended one of these refresher courses and experience has shown that such courses are for the good of the service. 112 TABLE No. 61. Tuberculosis.—Summary of Notifications received during the year ended 31st December, 1927. Age periods— Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 & upwards. Total Primary Notifications. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary Males . . . . 3 2 16 23 39 23 26 5 5 142 177 . . 1 . . 1 1 8 145 „ Females . . 4 5 1 32 15 36 20 8 5 126 151 . . . . . . . . . . 17 88 Non-Pulmonary Males . . 8 8 7 3 2 6 4 3 . . . . 41 49 . . . . . . . . . . . . 15 „ Females 2 5 9 7 3 4 9 . . 1 1 2 43 49 . . . . . . . . . . . . 20 Total 2 17 25 17 54 44 90 47 38 11 7 352 426 . . 1 . . 1 1 25 268 New Cases not Notified. Pulmonary Males . . . . . . . . 1 1 . . 3 2 . . 2 9 . . . . . . . . . . . . . . . . „ Females . . . . . . . . . . . . 1 3 1 . . 1 6 . . . . . . . . . . . . . . . . Non-pulmonary Males . . 1 1 . . . . . . . . 1 . . . . . . 3 . . . . . . . . . . . . . . . . „ Females . . . . . . . . . . . . 1 1 . . . . . . 2 . . . . . . . . . . . . . . . . Grand Total 2 18 26 17 55 45 92 55 41 11 10 372 426 . . 1 . . 1 1 25 268 113 Notifications. During 1927, 353 primary notifications of tuberculosis were received, details of which are given in Table No. 61. In addition, 74 notifications were received relating to cases which had been previously notified. Sixteen cases died before notification. The distribution of the disease amongst the various persons notified each year since 1923 was as shown in the following Table, No. 62. TABLE No. 62. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 1923 245 9 6 21 8 10 12 311 1924 273 8 6 16 22 6 11 342 1925 246 9 6 9 14 6 10 300 1926 287 8 6 14 11 7 16 349 1927 269 10 18 20 18 5 13 353 Cases of Tuberculosis in the District. It is the duty of the Medical Officer of Health to remove from the notification register entries relating to notifications in respect of persons who have died or ceased permanently to live in the district. Cases also are removed in which the diagnosis of tuberculosis is not confirmed or when a patient attains a condition in which he may be regarded as cured. H 114 During the year a careful survey was made of all cases on the register, and as a result many were removed under one or other of the above heads. In consequence of this action the number of known cases of tuberculosis living in the district at the end of the year was 1,496, a very considerable reduction on the previous published figures of 2,210. The following Table, No. 63, shows the number of cases on the register at the beginning of 1927, the changes which have taken place during the year, and the number remaining on the register at the end of the year. TABLE No. 63. Pulmonary. NonPulmonary. Totals. M. F. M. F. Number on Register at 1st January, 1927 919 758 276 257 2210 Number of additions 154 140 50 41 385 Number of Deletions 440 395 140 124 1099 Number on Register at 31st December, 1927 633 503 186 174 1496 Deaths. The number of deaths from tuberculosis was 178, 148 being certified as due to pulmonary tuberculosis and 30 to other forms. These figures compare with 165, 148, and 17 in 1926. The death-rate for all forms was 1.26. The following Table, No. 64, shows the number of deaths and death-rates from all forms of tuberculosis each year since 1912. 115 TABLE No. 64. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 1912 175 129 46 1.44 1.06 0.38 1913 218 184 34 1.78 1.50 0.28 1914 229 177 52 1.87 1.45 0.42 1915 237 197 40 1.83 1.52 0.31 1916 210 169 41 1.61 1.30 0.31 1917 215 176 39 1.63 1.33 0.30 1918 231 199 32 1.72 1.48 0.24 1919 196 171 25 1.44 1.26 0.18 1920 188 161 27 1.38 118 0.20 1921 207 168 39 1.50 1.22 0.28 1922 190 163 27 1.37 1.18 0.19 1923 191 172 19 1.36 1.22 0.14 1924 199 171 28 1.42 1.22 0.20 1925 187 160 27 1.33 1.14 0.19 1926 165 148 17 1.16 1.04 0.12 1927 178 148 30 1.26 1.05 0.21 In addition to the deaths recorded in the above Table, nine persons who had been notified as suffering from tuberculosis died during the year from other causes and detailed information as to these is given in the following Table No. 65. TABLE No. 65. Case No. Date notified as Tuberculosis. Cause of Death. 1 26/3/19 Acute bronchitis and heart failure. 2 13/5/18 Influenza. 3 24/1/25 Influenza, bronchitis and heart failure. 4 28/1/27 Epithelioma of brain. 5 7/6/27 Meningitis and exhaustion. 6 28/6/25 Appendicitis. 7 22/8/27 Pneumonia. 8 6/14 Heart failure during operation. 9 28/7/25 Bronchitis. 116 The period which elapsed between notification and death is as shown below:— TABLE No. 66. Pulmonary. Percentage. NonPulmonary. Percentage. Not Notified 11 7.43 5 16.67 0-1 month 25 16.89 15 50.00 1-3 months 11 7.43 — — 3-6 months 17 11.49 3 10.00 6-12 months 18 1216 2 6.67 1-2 years 25 16.89 1 3.33 2-5 years 26 17.57 1 3.33 Over 5 years 15 10.14 3 10.00 148 100.00 30 100.00 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as one is to twelve. In 1925 and 1926 it was as one is to eight. So far as efficiency of notification is concerned, the year's figures are an improvement on those of the previous two years, but it is still regretable to report that over one-third of the cases are not notified at all or only notified within three months of death. There is no evidence that this high percentage is due to wilful neglect or refusal to notify. The Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations provide for the compulsory discontinuance from employment of persons engaged in the handling or treatment of milk, who are suffering from 117 culosis. No action was taken under them during the year. Every milk vendor in the Borough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade. Although this letter is sympathetically received by the trade, no examinations were sought. The Work of the Dispensary. The Tuberculosis Dispensary is situated in Maxey Road, Plumstead, and consultations are held there, special days and times being allotted to men, women and children. These are given in tabular form below. At times when clinics are not held, the Tuberculosis Officer is either engaged in administration or in home visiting. Hours of Attendance. Day. Men. Women. Children. Tuesday — 9-12 9-12 Wednesday — 2-4 4-5.30 (Schools) Thursday 4-7.30 p.m. — — Friday 9-11 a.m. 4-5 2-4 Saturday — — 9-11 A return as to the work in connection with the Tuberculosis Dispensary during the year is given in the following Table No. 67 118 TABLE No. 67. Return showing the work of the Dispensary during the year 1927. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A. New CASES examined during the year (excluding contacts):— (a) Definitely tuberculous 98 95 6 9 5 14 8 13 103 109 14 22 (6) Doubtfully tuberculous . . . . . . . . . . . . . . . . 14 27 11 8 (c) Non-tuberculous . . . . . . . . . . . . . . . . 195 206 190 191 13. CONTACTS examined during the year:— (a) Definitely tuberculous . . 1 1 9 . . . . . . . . . . 1 1 2 (6) Doubtfully tuberculous . . . . . . . . . . . . . . . . . . 2 . . 4 (c) Non-tuberculous . . . . . . . . . . . . . . . . 49 88 58 83 C. CASES written off Dispensary register as (a) Cured 203 171 19 19 43 35 29 15 246 206 47 34 (6) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) . . . . . . . . . . . . . . . . 279 339 267 288 D. NUMBER OF PERSONS on Dispensary register on December 31st:— (a) Diagnosis completed 480 398 35 36 55 65 44 42 535 463 79 78 (6) Diagnosis not completed . . . . . . . . . . . . . . . . 4 9 3 3 119 (1) Number of persons on Dispensary Register on January 1st 1,809 (2) Number of patients transferred from other areas and of "lost sight of " cases returned 7 (3) Number of patients transferred to other areas and cases "lost sight of " 198 (4) Died during the year 115 (5) Number of observation cases under A (6) and B (6) above in which period of observation exceeded 2 months 24 (6) Number of attendances at the Dispensary cluding Contacts) 5,014 (7) Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision Nil (8) Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for— (а) "Light" treatment 302 (b) Other special forms of treatment .. 58 (9) Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 20 (10) Number of consultations with medical practitioners— (a) At Homes of Applicants 44 (b) Otherwise 884 (11) Number of other visits by Tuberculosis Officers to Homes 523 120 (12) Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,802 (13) Number of (а) Specimens of sputum, etc. examined 598 (b) X-ray examinations made in connection with Dispensary work 78 (14) Number of Insured Persons on Dispensary Register on the 31st December 394 (15) Number of Insured Persons under Domiciliary Treatment on the 31st December 286 (16) Number of reports received during the year in respect of Insured Persons— (а) Form G.P. 17 5 (b) Form G.P. 36 249 Contacts. Contacts are those persons who are examined by reason of the fact that they have recently been, or still are, living in contact with a dispensary patient or other notified case. It does not include those persons who may give a history of previous contact with a case of tuberculosis. Such cases are graded as new cases for the purposes of Table No. 67. The definition is the official one of the Ministry of Health and is laid down in Memorandum 121 T. It is clear that such a definition limits the numbers who would be regarded as contacts by the medical profession and by the general public. Even when allowance is made for this the number of "contacts" who present themselves for examinations each year is disappointing, particularly when it is remembered that special arrangements are made and appointments fixed for their examination. 121 Such evidence as is available would tend to show that the risk of infection amongst " contacts " is not greater than amongst the rest of the population, but this aspect of the tuberculosis problem is being carefully investigated at the present moment by the Joint Tuberculosis Council for England, of which the Tuberculosis Officer is a member. There are certain dramatic exceptions, well known to all tuberculosis workers, where certain families appear to have no resistance to this disease and members contract it one after the other with fatal results. Claims have been made from abroad that exceptionally good results have been obtained by special inoculation treatment, and so far the results seem to justify more attention being paid to this aspect of preventive work. Co-operation with Hospitals, etc. Arrangements for cooperation with general hospitals in London were fully reported on in the Annual Reports for 1925 and 1926 and these arrangements were in operation throughout the year. 78 cases were referred to the Seamen's Hospital for X-Ray examination; no cases were referred to the London Hospital for treatment of lupus ; 10 cases, involving 389 treatments, were sent to the Miller Hospital for treatment by ultra-violet rays; and 5 cases, involving 58 attendances, were referred to the Brompton Hospital for pneumo-thorax refills. As in previous years, children, who though non-tuberculous were found to require medical treatment for other conditions, were referred to other agencies. Thirty children were referred to the Woolwich Branch of the Invalid Children's Aid Association for treatment at convalescent homes or at the remedial clinic of the Association. Co-operation with Local Practitioners. Whenever a notification is received a letter is sent to the notifying practitioner in which he is informed that the Tuberculosis Officer will be pleased to give such assistance as is in his power regarding 122 the patient. In other instances the Tuberculosis Officer is asked to see patients in consultation at their homes, or the patients are referred to the Dispensary. In consequence of these customs, 523 persons were seen by the Tuberculosis Officer at their homes, and 884 were referred to the Dispensary for examination. Many patients who are examined at the Dispensary are advised to consult their own doctors, and in this connection 688 written opinions were given by the Tuberculosis Officers. These letters and reports are in addition to those required under the National Health Insurance Acts. Co-operation with the School Medical Service. There is close co-operation between the School Medical Service and the Tuberculosis Officer, by means of which the School Medical Officers can refer ailing children to the Dispensary, and the Tuberculosis Officer can refer cases to the School Medical Service for supervision. Under this arrangement special attention is paid to children who are " contacts " of tuberculous patients who have tubercle bacilli in their sputum. These children are periodically examined by the School Medical Officers, and at intervals the Tuberculosis Officer and the Divisional School Medical Officer discuss what other steps, if any, are necesary. Other children are referred to the School Medical Service for the treatment of minor ailments and dental caries. Home Nursing. For home nursing the services of the local voluntary nursing associations are sought and readily given. During the past year, as in previous years, the assistance given by these bodies has been most valuable and of the highest order. Those suffering from advanced disease or active disease necessitating rest in bed are grateful for the help so freely and voluntarily given. 123 Extra Nourishment. Extra nourishment in the form of butter, eggs and milk, is supplied to tuberculous patients on the certificate of the Tuberculosis Officer. The expenditure on this service is limited to £2 per 1,000 population. These recommendations by the Tuberculosis Officer are approved by a special committee of the Tuberculosis Care Committee and reported to the Public Health Committee of the Council. Any nourishment ordered is only sanctioned for four weeks at any one time. Dental Treatment. Dental work is carried out at the School Clinic, Brewer Street, Woolwich, patients being referred there from the Dispensary. During the year 20 patients received treatment, the number of attendances being 39. The treatment is free except where dentures are required, and then patients are assessed according to their means, each case being treated on its merits. Dentures were supplied in 13 instances at a cost of £54 10s. 0d., and during the year the income received under this head was £10 8s. 6d. Shelters. Thirteen shelters are maintained by the Council for the use of the patients returning from sanatoria who are able to continue this form of open-air treatment. They are lent by the Council in many cases free, but in some instances at rents not exceeding 6d. per week. Bacteriological Examinations. During the year 598 specimens of sputum were examined at the Dispensary, of which 85 were positive and 513 negative. Facilities for general practitioners are provided at the Seamen's Hospital, Greenwich, and 391 specimens were examined there during the year, 74 being positive and 317 negative. Institutional Treatment. The following Table, No. 68, shows the number of admissions to hospitals, sanatoria, Poor Law Institutions and training Colonies. 124 TABLE No. 68. Hospitals. Sanatoria. Infirmary. Training Colony. Insured 121 62 50 3 Uninsured 75 34 36 2 Children 60 2 13 — 256 98 99 5 These numbers refer to 293 patients, and the monthly admissions from January to December, 1927, were as follows:— January 22 July 37 February 43 August 45 March 43 September 6 April 37 October 53 May 45 November 34 June 49 December 44 Woolwich Tuberculosis Care Committee. At the end of the year the Committee was constituted as follows :— Bodies. Representatives. Woolwich Borough Council Alderman Mrs. E. Dormer, J.P. ; Councillors R. A. M. Walters, P. Chinnery, Miss M. Crout, J.P., W. E. Hughes Narborough, Miss G. E. Walters, J.P. Woolwich Board of Guardians Captain W. T. Cusheon, Mrs. E. M. Newman. Lewisham Board of Guardians Mrs. Phillips. Trade Unions Mr. W. H. Fail-child, Mrs. Jennings Mr. T. R. Goy. 125 Bodies. Representatives.[/$$$] Employers Miss L. Ames, Miss Fletcher, Mr. A. E. Welford. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke Mr. F. Smyth. London Insurance Committee Mr. W. Edwards. Panel Committee for the County of London. Dr. J. J. O'Mullane. War Pensions Committee Mr. E. J. Cole. Woolwich Invalid Children's Aid Association. Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee Mr. E. G. Dixon, Mr. W. Dashwood. United Services Fund Ex-officio Miss M. Shaw. Voluntary Visitors Miss L. Bloxam, Miss L. Mac Dermott. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan. It is the duty of the Care Committee to ensure that no stone shall be left unturned to help the patients to carry out the recommendations made by the Tuberculosis Officer ; it advises and assists these according to the circumstances of the case. During the year 47 dispensary patients have been helped by the provision of extra clothing, where necessary, required by the institution to which the patient is to be admitted ; by supplying the necessities for domiciliary treatment, which a patient is unable to provide for himself ; by making arrangements for the welfare of the family while the father or the mother are away in hospital, and in other divers ways. It makes recommendations to the Public Health Committee as to the cases which should receive extra nourishment under the Council's scheme, and as to the assessment which should be made where dentures are recommended 126 by the Tuberculosis Officer. It also reviews the economic circumstances of the patients and forwards reports to the London County Council on each case recommended for institutional treatment, suggesting what the assessment per week should be. Under their Grancher Scheme, eleven children were boarded out. These children are non-tuberculous children who are living in infected homes and who are placed in carefully selected homes in better surroundings. At the end of the year, three children were still away from home. These activities mean money, as the only expenditure of the Committee which is rate assisted is the provision of secretarial assistance and stationery, and as there is a paucity of Woolwich organisations able to help it is necessary for the Care Committee to obtain voluntary funds. During the year, from various sources, the sum of £285 9s. 8d. was raised for the Care Fund, the total expenditure being £195 l1s. 9d. The Committee meets four times a year but it operates by means of Sub-Committees which meet periodically. The General Purposes and Assessment Sub-Committee meets once a week, and the Finance and Grancher Sub-Committees meet when required. During the year the Committee dealt with 558 cases. 127 SECTION VIII.—MATERNITY AND CHILD WELFARE. Staff. The staff at the end of the year is shown in detail in Section III. It consists of one whole-time Medical Officer, one half-time Medical Officer, six Health Visitors, two Sanitary Inspectors and Health Visitors, one Health Visitor and Sunlight Clinic Nurse, and two Clerks. In addition to these, a band of voluntary workers attend the centres regularly each week and assist the staff. Their services are greatly appreciated. Administrative Action in Connection with the Notification of Births. Under the terms of the Notification of Births Acts, 1907-1915, notification of every birth in the Borough has to be sent to the Medical Officer of Health within 36 hours of birth, and it is customary to send appropriate literature to the mother as soon as the notification is received. When the doctor or midwife has ceased to attend, a visit is paid by one of the Health Visitors, in all cases where such visits are considered necessary or desirable. The visit usually takes place about the fourteenth day. The necessity for subsequent visitation is judged by the impressions gained by the Health Visitor on her first visit, but as a general rule the following standard is adhered to:—three visits during the first year and one visit in each subsequent year up to the age of five years. When notification is received from other Medical Officers of Health, of Woolwich births outside the borough, the same procedure is followed out. Notifications in the borough regarding children of non-Woolwich residents are referred to the Medical Officer of Health concerned. 128 Welfare Centres. In Woolwich all the centres with one exception are municipal, and two changes took place during the year. These changes were not additions but consequent upon change of premises, the centres at the Town Hall and Beresford Street being transferred to the Old Town Hall and the Holy Trinity Church Halls respectively. At the end of the year 4 ante-natal clinics, and 17 infant welfare sessions were being held each week. Old Town Hall Centre and Artificial Sunlight Clinic. It had been felt for some time that the Town Hall Centre, consisting of rooms in the basement of the Town Hall buildings, had become too small and inconvenient for the work which was being done there, and that the time had arrived when an artificial sunlight clinic should be established in Woolwich. Suitable accommodation for these purposes was found on the ground floor of the Old Town Hall. The work of reconstruction was commenced in the Spring and carried out by direct labour under the Borough Engineer. In the plan of the building, which appears on page 129, all the rooms are fully described and further explanation is unnecessary here. The doctor's room is the centre of the organisation and is used for the sunlight consultations as well. The opening of this new centre and sunlight clinic formed a very appropriate inauguration of Health Week. It was opened by His Worship the Mayor and was available for inspection by the general public during the week. It began to function as a centre on the 3rd October, and as a sunlight clinic on the 7th October. The Work of the Centres. Tables Nos. 69 and 70, which follow, give detailed statistics for the year 1927 and the consolidated statistics for the year 1926. The attendances at the centres, although up to the average of previous years, were slightly lower than in 1926. 131 TABLE No. 69. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 344 316 1,535 515 611 8,346 Eltham 237 78 1,207 413 143 6,218 Plumstead 168 229 1,060 305 415 6,367 Slade 15 77 384 16 152 3,403 New Eltham 11 9 223 4 17 2,004 North Woolwich 6 17 143 7 28 1,010 Beresford Street (Voluntary) 6 42 128 13 77 756 Totals 1927 „ 1926 787 751 768 680 4,680 4,884 1,273 1,245 1,443 1,403 28,104 29,205 132 TABLE No. 70. Children in Attendance at each Centre. Year of Birth. Town Hall Eltham. Plums tead. Slade New Eltham. North Woolwich. Beresford St. (Voluntary). Totals. 1927 477 289 306 104 65 47 36 1,324 1926 489 329 331 111 57 47 32 1,396 1925 258 198 185 63 45 20 26 795 1924 156 156 112 52 30 14 22 542 1923 102 165 85 40 14 13 9 428 1922 53 70 41 14 12 2 3 195 1,535 1,207 1,060 384 223 143 128 4,680 Attendances of Children at each Centre. 1927 2,839 1,939 2,111 1,061 603 410 223 9,186 1926 3,384 2.399 2,718 1,281 870 375 244 11,271 1925 1,129 785 795 462 276 126 140 3,713 1924 564 485 365 326 144 79 115 2,078 1923 279 443 285 213 71 16 23 1,330 1922 151 167 93 60 40 4 11 526 8,346 6,218 6,367 3,403 2,004 1,010 756 28,104 133 Sunlight Clinic. The Medical Officer in charge of this centre is Dr. J. E. A. Lynham, who is the physician-in-charge of the Electro-Therapeutic section of the War Memorial Hospital. He attends fortnightly and generally supervises the treatment which is carried out by the Council's staff. The Clinic was only working at full capacity during the last few weeks of the year and it is yet too early to report fully on its working. Two lamps are in use—one carbon-arc and one mercury-vapour. During the period 99 children commenced treatment; 31 of these were suffering from rickets, 34 from debility or malnutrition, 12 from bronchitis or other catarrhal conditions, 10 from anaemia and 12 from other diesases. The total number of treatments given was 1,639. Voluntary Centre. There is only one voluntary centre in Woolwich. It was originally established at the Victory Club in Beresford Street and serves one of the most difficult areas in the borough. During the year, owing to a change of ownership of the Club, it was necessary to move the centre, and suitable premises were found at the Holy Trinity Church Halls in the same street. The number of children attending the centre was 128. The total number of attendances, including mothers, was 846. As in previous years one of the Council's Assistant Medical Officers attended this centre every alternate Monday, and a Health Visitor attended at each session. The Council do not make a grant towards the expenses of this centre. Collective Teaching. In the Annual Report for 1926 a description is given of the Council's mothercraft classes, and they were continued on the same lines during 1927. The response to these classes has been somewhat disappointing but it was better than it was the previous year, and it is thought it may continue to grow. In these classes collective and individual teaching has been given so that every mother 134 could make the garment she chose and use any materials she already had. Planning and cutting out has been done at the centre and most of the sewing, but in some cases work has been taken home to finish. The total attendances were 599. In addition to these classes a course of lectures was arranged at the Plumstead Centre on Friday afternoons. The average attendance was 13. The lectures and lecturers were as set out below :— Jan. 7th—How Father Can Help You : Mr. A. G. Duck, Chief Sanitary Inspector. ,, 14th—The Bathing of Baby : Miss F. Morgan, Health Visitor. „ 21st—Questions and Answers : Dr. R. Mackenzie, Assistant Medical Officer. ,, 28th—The Clothing of Baby : Miss W. Seccombe, Health Visitor. Feb. 4th—Preparation for Motherhood : Mrs. M. Garside, Health Visitor. ,, 11th—How to Guard Against Tuberculosis : Dr. F. Blackmore, Tuberculosis Officer. „ 18th—The Feeding of the Toddler : Miss W. Burnett, Health Visitor. ,, 25th—The Nursing of the Sick Baby : Miss F. Morgan, Health Visitor. March 4th—Questions and Answers : Dr. R. Mackenzie, Assistant Medical Officer. 135 March 11th—The Care of the Infectious Child : Miss M. Campbell, Health Visitor. „ 18th—The Care of Children's Teeth : Mr. R, J. Spaull Ellis, L.D.S. ,, 25th—The Clothing of the Toddler : Miss W. Seccombe, Health Visitor. April 1st—The Feeding of Baby : Miss W. Burnett, Health Visitor. ,, 8th—Common Enemies in the Home : Mr. A. G. Duck, Chief Sanitary Inspector. Treatment of Minor Ailments. Children requiring medical or surgical treatment for certain minor ailments are referred to the School Clinic, Brewer Street, to a private practitioner, or to a hospital. During the year 37 were sent to this clinic, and for each case the Council paid 5s. Children referred there suffered from the following conditions :— TABLE No. 71. Impetigo 18 Ear Discharge 10 Eyes—squint 6 Miscellaneous 3 37 The Work of the Health Visitors. The work carried out by the Council's Health Visitors during 1927 is set out in detail in Table No. 72, which follows. During 1927 the Council, with the approval of the Ministry of Health, paid the class fees and expenses of two Health Visitors attending a refresher course for Health Visitors. 136 TABLE No. 72. 1927. Births—First visits 1,977 „ Re-visits 12,211 Infant deaths investigated 52 Still-births investigated 42 Expectant mothers—home visits 264 Infectious diseases :— Ophthalmia Neonatorum—First visits 19 ,, ,, Re-visits 24 Measles—First visits 133 „ Re-visits 24 Puerperal Fever—First visits 8 „ „ Re-visits 7 Puerperal Pyrexia—First visits 25 „ ,, Re-visits 14 Zymotic Enteritis—First visits 5 „ ,, Re-visits 3 Tuberculosis 4 Pneumonia 133 Anterior Poliomyelitis 13 Encephalitis lethargica 2 Visits unclassified 285 Visits unsuccessful 1,806 17,232 Orthopaedic Treatment for Children under Five years of Age. Children requiring orthopaedic treatment are sent to the remedial clinic of the Woolwich Invalid Children's Aid Association in accordance with the scheme adopted in 1925. The Council pay for children under five years of age, sent by the medical officers to the clinic, 2s. Od. per attendance for cases requiring massage or electrical treatment, and 1s. 6d. per attendance for any other form of treatment. The 137 cost of these services for the year was £151. Only cases recommended by the Medical Officer of Health are included in this scheme, and payment is only made for the number of attendances approved by him. In detail, the children referred to the clinic required treatment for the following conditions:— TABLE No. 73. Type of Case. Number remaining over from 1926. New Cases. Total Cases Number who completed treatment by end ef year. Talipes (Club foot) 8 8 16 14 „ (Flat foot) 2 — 2 1 Rickets— General 5 14 19 16 Genu Valgum (Knock knee) 2 5 7 4 Genu Varus (Bow leg) 1 23 24 9 Paralysis, etc.— Infant 2 4 6 4 Erbs 2 — 2 1 Muscular weakness 1 5 6 6 Miscellaneous— Injuries 1 — 1 1 Hernia — 1 1 1 Constipation — 1 1 — Flat Chest 1 2 3 3 Rheumatism 1 — 1 1 26 63 89 61 138 Dental Treatment. Dental work is carried on at the School Clinic, Brewer Street. Mothers and children are referred there from the centres. The following Table, No. 74, shows the cases attending and the total attendances during the year. The number of sessions was 28, excluding anaesthetic days. TABLE No. 74. No. Attendances Expectant mothers 60 103 Nursing mothers 46 138 Children under 5 178 232 284 473 Dentures are provided free, at part cost, or at cost price, according to ability to pay, and payment is spread over many weeks. In consequence, the income received during the year includes money received in respect of dentures supplied in previous years. 25 sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £101 10s. Payments by patients amounted to £76 2s. 6d. Institutional Midwifery. The British Hospital for Mothers and Babies is a voluntary hospital with 42 beds. The Council's arrangements with the hospital were fully reported on in the Annual Report for 1925. During the year, 144 cases were admitted under the Council's scheme, and the amount recovered in patients' fees during the year was £522 8s. l0d. The nett cost to the Council was £981 11s. 2d., 50 per cent, of which was recoverable from the Ministry of Health. I am indebted to Miss Gregory, the Secretary of the Hospital, for the following information, which shows statistically the number of cases dealt with during the year:— 139 Mothers admitted during the year 645* Number of children born 655 Maternal deaths — Infant deaths 7 Extern cases 198 Ante-natal Clinic— Mothers attending 1,261 Total attendances 4,300 Post-natal Clinic— Mothers attending 50 Total attendances 63 Infant Clinic— Infants attending 432 Total attendances 1,667 * Includes those for observation and temporarily discharged. Institutional Provision for Unmarried Mothers. Woolwich and Plumstead Maternity Home. This is a small home for unmarried mothers, situated at 23, Vicarage Park, Plumstead, which provides accommodation for eight mothers and babies. Through the courtesy of the Superintendent, I am able to give the following information :— Mothers in the Home on 1st January, 1927 5 Babies do., do. 4 Mothers admitted during the year 15 Births 11 Deaths — Average duration of stay of each completed case 6 months. Mothers who attended ante-natal clinics of the Borough Council 13 140 The function of the Home is to give illegitimate children a chance of survival, and the mothers are kept in the Home doing the light work of the Home for about six months. When they leave, situations are found for them, if possible, where the child can be taken. Nursing Assistance. Previous to 1926, nursing assistance was only provided by the Council under this scheme for cases of measles and ophthalmia neonatorum. In 1926, these services were extended to include cases of zymotic enteritis, puerperal fever, acute poliomyelitis, and whooping cough, and in October, 1926, puerperal pyrexia. Cases of these diseases which come to the notice of the Medical Officer of Health are visited by the health visitor, and the Medical Officer of Health decides whether nursing is required. The Council do not pay a retaining fee to the District Nursing Association, but they pay a fee per visit, the rate being as follows:— in the case of all these diseases, except puerperal fever and puerperal pyrexia, 1s. per visit for one case, and 6d. a case for more than one case in the house at the same time; for puerperal fever and puerperal pyrexia, a uniform fee of 1s. 3d. per visit is paid. Research Work on the Health of the Toddler. At the request of the Ministry of Health, arrangements were made to keep under observation, for a period of three years ending May, 1928, a certain number of children between the ages of one and five years coming within the three following groups:— (1) Unselected children in attendance at an Infant Welfare Centre. (2) Catarrhal children in attendance at an Infant Welfare Centre. (3) Two, or more children in the same family—" Good " and " Bad " families. 141 This work, which was done by Dr. C. I. Wright, was carried on throughout the year. Widows', Orphans' and Old Age Contributory Pensions Act, 1925. In January a letter was received from the Ministry of Health, asking for investigation into the circumstances of a representation made under the above Act with reference to the administration of a pension to a widow and her child. The Woolwich Invalid Children's Aid Association represented that a prolonged convalescent treatment was arranged for the child and that the woman had arranged to pay to the association the child's allowance under the Act. These payments fell into arrears and the Association asked that the allowance should be diverted to them. After careful investigation, the Minister was informed that the Council were of opinion that it was in the interests of the child that the additional allowance should be administered by the Woolwich Invalid Children's Aid Association so long as the child was at the home referred to. Subsequently, the Council were informed that the Minister, acting in accordance with Section 6 (2) of the Act had directed that as from 7th March, 1927. the allowance payable under the Act in respect of the child should be paid to the Woolwich Invalid Children's Aid Association, to be administered for the benefit of the child. Supply of Milk, etc., to Necessitous, Expectant and Nursing Mothers, and Milk to Young Children. Under the provisions of the Maternity and Child Welfare Act, 1918, milk, etc., is provided by the Council for necessitous, expectant and nursing mothers, and children under the age of five years under the conditions laid down by Circular 185 issued by the Ministry of Health in March, 1921. The approximate cost of this service during the year, was as follows :— Dried Milk, £1,197 3s. 2d. ; Fresh Milk, 19s. 4d.; Dinners, nil. 142 Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. These Regulations came into force on the 1st October, 1926, and made notifiable, in addition to puerperal fever, puerperal pyrexia, which is defined as follows:— "Any febrile condition (other than a condition which is required to be notified as puerperal fever under the Infectious Disease (Notification) Acts) occurring in women within 21 days after child-birth or mis-carriage in which a temperature of 100.4 deg. Fahrenheit (38 deg. Centigrade) or more has been sustained during a period of 24 hours, or has recurred during that period." Their object is to ensure the organisation of proper measures for the prompt and effective treatment of a septic puerperium. It was recognised that the number of notifications would increase, and would include many cases relatively trivial in degree, but the great importance of securing adequate treatment in the early stages of puerperal infection was regarded as outweighing any objection to the notification of a certain amount of minor illness which gives no cause for anxiety. In my report for 1926, I stated that the Council's scheme was receiving consideration at the end of the year. The scheme, as ultimately approved by the Ministry, is as follows :— (a) Mr. H. G. Taylor, F.R.C.S., has been appointed as Consultant at a fee of £3 3s. Od. per consultation with the addition of £1 1s. 0d. for the time spent in travelling, and a further fee of £1 1s. Od. if treatment is carried out, with a minimum annual payment of 20 guineas. 143 (6) Arrangements have been entered into with the Seamen's Hospital Society for carrying out the bacteriological work under the regulations at a fee of half-a-guinea per examination, the fee to cover the supply of the necessary outfits. If the bacteriologist is required to attend at the home of the patient, an additional fee of one guinea is charged. (c) Under the general nursing arrangements in force, provision has been made for the nursing of cases of Puerperal Fever and it was only necessary to extend these arrangements for the nursing of cases of Puerperal Pyrexia. A fee of Is. 3d. per visit is paid for each approved visit. It was unnecessary to make provision for hospital treatment because of the general provisions in force in the administrative county for the use of the hospitals of the Metropolitan Asylums Board. By the end of the year one patient had been examined by Mr. Taylor. Two bacteriological examinations were made and nursing assistance was provided in three instances. The statistics relating to the incidence of Puerperal Fever and of Puerperal Pyrexia are given in that part of the report dealing with the prevalence and control of infectious disease. Feeding of Infants in Woolwich. The usual enquiry was carried out in the months of July and August, and the results are very similar to those obtained in the six previous years. Table No. 75 shows the result of the enquiry. 144 TABLE No. 75. Feeding of Infants Attending Welfare Centres, 4th July to 12th August, 1927. Method of Feeding. Age in Months. 0-1. 1-2. 2-3. 3-4. 4-5. 5-6. 6-7. 7-8. 8-9. Total. 9-10. 10-11. 11-12. Grand Total. Breast 37 69 55 34 47 28 21 19 10 320 5 1 1 327 Breast and Hand 8 12 16 6 9 11 9 5 12 88 13 7 7 115 Hand 8 13 23 21 22 25 37 42 28 219 34 36 42 331 Total 53 94 94 61 78 64 67 66 50 627 52 44 50 773 Percentages. Breast 69-8 73.4 58.5 55.8 60.3 43.7 31.3 28.8 20.0 51.0 9.6 2.3 2.0 42.3 Breast and Hand 15.1 12.8 17.0 9.8 11.5 17.2 13.5 7.6 24.0 14.0 25.0 15.9 14.0 14.9 Hand 15.1 13.8 24.5 34.4 28.2 39.1 55.2 63.6 56.0 35.0 65.4 81.8 84.0 42.8 145 METEOROLOGY. Meteorological Observations taken at the Royal Observatory Greenwich, during the year 1927. Week ending. Temperature of the Air. Departure from aver. age mean air temperature for 65 years. Average Temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. Jan. 8 50.6 32.8 42.3 + 41 44.7 5 0.17 15 52.9 29.9 43.6 + 5.6 44.8 3 0.26 22 44.0 24.0 34.9 — 3.8 44.2 4 0.70 29 52.1 30.1 43.8 + 4.5 43.1 4 0.32 Feb. 5 50.3 27.4 39.7 + 0.2 43.2 4 10.2 12 47.0 25.0 34.6 — 4.6 42.6 1 0.32 19 52.8 28.9 39.8 + 0.4 43.0 26 56.3 33.0 45.1 + 5.2 42.7 7 1.50 March 5 55.8 41.7 47.6 + 7.1 43.5 6 0.95 12 53.8 33.1 43.1 + 2.1 44.0 5 0.44 19 62.2 29.9 45.1 + 3.3 43.9 1 0.02 26 68.1 38.7 48.9 + 6.6 44.4 5 10.1 April 2 60.2 29.4 45.1 — 0.6 45.0 4 0.44 9 61.0 33.9 45.7 — 0.4 45.2 6 1.50 16 64.6 34.7 48.1 + 1.8 45.6 3 0.06 23 72.4 35.2 53.0 + 4.6 46.5 . — 30 62.4 28.1 46.3 — 2.4 47.1 2 0.06 May 7 75.1 29.9 56.9 + 6.9 47.9 2 0.32 14 72.1 36.2 51.8 — 0.0 48.9 — — 21 71.1 38.1 54.9 — 1.4 49.5 3 0.38 28 76.5 33.0 52.3 — 3.2 50.1 2 0.50 June 4 69.9 35.3 55.9 — 1.5 50.8 2 0.02 11 69.0 43.1 55.2 — 3.0 51.2 4 0.19 18 84.9 41.8 59.0 + 0.2 51.9 2 0.48 25 70.3 46.1 57.5 — 3.0 52.7 5 0.61 146 METEOROLOGY—continued. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average Temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. July 2 73.4 43.1 55.5 — 6.1 53.0 6 1.45 9 79.2 51.2 62.6 + 0.3 53.8 5 0.90 16 81.2 52.6 60.5 — 2.6 55.1 3 0.56 23 73.9 52.1 59.4 — 3.8 55.4 3 0.34 30 77.6 52.2 62.9 + 0.4 56.0 2 0.27 Aug. 6 77.2 49.0 63.4 + 1.3 56.8 4 0.73 13 75.5 53.2 62.7 + 0.3 57.4 6 0.87 20 73.8 49.1 59.1 — 3.0 57.9 6 1.59 27 73.0 46.9 59.2 — 1.8 57.8 4 0.40 Sept. 3 77.2 48.3 62.6 + 2.7 57.6 . 10 71.4 43.7 59.2 + 0.2 57.7 2 0.52 17 66.6 46.2 54.2 — 3.5 57.1 5 2.07 24 69.0 42.8 56.2 + 0.2 56.7 6 1.07 Oct. 1 62.8 34.7 50.3 — 4.5 55.8 3 0.46 8 65.2 33.9 49.3 — 3.5 54.6 1 0.05 15 61.7 37.9 49.8 — 0.9 53.4 2 0.02 22 60.4 38.2 48.9 — 0.2 52.9 3 0.32 29 66.2 33.7 55.3 + 7.7 52.3 4 0.41 Nov. 5 67.0 38.1 54.7 + 7.9 52.7 4 0.78 12 49.5 29.2 38.1 — 6.6 52.0 1 0.01 19 53.0 32.4 43.8 + 0.9 50.0 2 011 26 53.4 28.8 42.6 — 0.4 49.2 3 0.65 Dec. 3 47.1 33.2 40.3 — 0.9 48.3 2 102 10 54.0 33.5 41.7 — 0.7 47.6 2 0.03 17 38.1 20.8 33.9 — 6.7 46.8 1 0.25 24 54.2 18.5 36.7 — 2.1 45.2 4 110 31 45.1 19.4 31.8 — 7.0 44.5 4 1.85